High-volume surgeon, better chance of patient survival

Certain cardiac and cancer-related surgeries studied

Published December 1, 2003; Category: DARTMOUTH MEDICAL SCHOOL

Seeking out surgeons who frequently perform certain cardiac or cancer-related operations may increase patients' odds of surviving major surgery, according to a study published in the Nov. 27 issue of the New England Journal of Medicine.

Researchers led by John D. Birkmeyer, Chief of General Surgery at Dartmouth-Hitchcock Medical Center and Associate Professor of Surgery at Dartmouth Medical School, examined outcomes from eight commonly performed cardiovascular procedures or cancer resections. Their findings reveal that patients of high-volume surgeons had lower death rates than did patients whose surgeons performed these operations less frequently.

This builds on previous research conducted by Birkmeyer and others that has demonstrated the link between hospitals with high annual volumes of certain types of surgical procedures and positive patient outcomes. This is the first major study, however, to look at the relative importance the experience of the operating surgeon can have on surgical patient death rates.

"For years, we've known that patients facing surgery are best served if they choose a hospital with high volumes for that specific surgical procedure," Birkmeyer said. "What this shows though, is that patients can improve their chances of survival substantially - even at hospitals with high volumes of a procedure - by selecting surgeons who perform the operations frequently."

Using Medicare data, the research team examined mortality rates for 474,000 patients who had undergone heart bypass surgery, carotid endarterectomy, lung or pancreatic resection, aortic valve replacement, repair of abdominal aortic aneurysm, esophagectomy, or cystectomy.

The likelihood of operative death for low-volume surgeons' patients was 24 percent greater for lung resection - an operation in which part or all of a lung is removed - and nearly four times greater for pancreatic resection surgery, as compared with patients of high-volume surgeons.

The study was funded in part by a grant from the Agency for Healthcare Research and Quality and the Center for Medicare and Medicaid Services.