Surgeons' experience produces lower death rates

AORN Journal, Feb, 2004

Patients of surgeons who perform large numbers of certain cardiac and cancer-related procedures have better odds of surviving these major surgeries, according to a Nov 26, 2003, news release from the Agency for Healthcare Research and Quality. Researchers found that patients of high-volume surgeons had lower death rates for heart bypass surgery, carotid endarterectomy, lung resection, and five other procedures than did patients whose surgeons performed these procedures less frequently. Patients of low-volume surgeons had death rates that were 24% greater for lung resection and nearly four times greater for pancreatic resection than those of patients of high-volume surgeons.

Researchers studied information from the national Medicare claims database on nearly 475,000 patients who underwent one of eight cardiovascular or cancer surgeries between 1998 and 1999. Findings were adjusted to account for factors that could affect the odds of surviving major surgery, such as patients' age, gender, race, average income, presence of other illness, and whether surgery was performed as an elective or emergency procedure.

Previous research has found that hospitals in which high annual numbers of certain procedures are performed have lower death rates than hospitals in which the volume of these procedures is low. Few studies have examined why high-volume hospitals have better results and how hospital volume and surgeon volume relate to surgical patient death rates, however. In this study, surgeon volume accounted for much of the effect of hospital volume, ranging from 100% for aortic valve replacement to 24% for lung cancer. The study also found that patients of high-volume surgeons had tower death rates even when the procedure was performed in a low-volume hospital. Patients of low-volume surgeons had higher death rates even if their procedure was performed in a high-volume hospital.

In this study, high-volume surgeons performed an average of more than 162 heart bypass procedures and more than 40 carotid endarterectomies per year, compared to fewer than 101 and 18 per year, respectively, for low-volume surgeons. High-volume surgeons performed an average of more than 17 lung resections and four pancreatic resections annually, compared to fewer than seven and two, respectively, for low-volume surgeons. Surgical mortality was defined as death during the procedure, before hospital discharge, or within 30 days of surgery.

New Study Suggests that Death Rates for Some Cardiac and Cancer Surgeries May Be Linked to Surgeons' Experience (news release, Rockville, Md: Agency for Healthcare Research and Quality, Nov 26, 2003).