Need Surgery? Choose a Larger Hospital

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Need Surgery? Choose a Larger Hospital

Survival Rates Higher at Hospitals With Higher Volume

Original page:http://my.webmd.com/content/Article/77/95451.htm

WebMD Medical News http://my.webmd.com/content/article/77/95451.htm

Nov. 25, 2003 -- Large regional hospitals may be farther away, but your

chances of surviving high-risk surgery there are better.

In fact, larger hospitals do high-risk procedures more frequently, and

high volume typically means lower death rates, writes lead researcher

D. Birkmeyer, MD, a surgeon with the Dartmouth-Hitchcock Medical

Center in Lebanon, N.H.

Birkmeyer is also a researcher with the Leapfrog Group, a for-profit

coalition that encourages people to receive care at hospitals that meet

certain volume criteria. His report appears in the Nov. 26 issue of The

Journal of the American Medical Association (JAMA).

Hundreds, if not thousands, of patients die every year because they had

high-risk surgery in small hospitals where the procedure is not

performed very often, writes Birkmeyer. " For many surgical procedures,

mortality rates are substantially lower at hospitals that perform them

more frequently. "

But would going to a larger hospital -- rather than the local hospital

-- involve traveling such long distances that someone might be deterred

from having surgery? There has been little research looking at this

issue, he says.

In his study, Birkmeyer and his colleagues used national Medicare data

and U.S. road network information. Their goal: to see just how travel

time would be affected if patients were required to travel to

high-volume centers for surgery.

Specifically, they looked at two surgical procedures -- one involving

the pancreas and the other involving the esophagus, which are performed

infrequently in smaller hospitals. Medicare data showed that death rates

were 12% higher when the procedures were performed at very low-volume

hospitals, reports Birkmeyer.

They matched patients' ZIP codes with ZIP codes for the hospital where

they had their surgery. Then they matched ZIP codes for a higher-volume

hospital. They also factored in travel costs, travel speed, available

highways and ferry crossings, and travel time. Low volume was defined as

performing one or two surgeries per year, and very high volume was

defined as more than 16 surgeries per year.

The results:

* With both types of surgery, 61% of patients traveled less than 30

minutes to a low-volume hospital; 76% less than one hour; 10% traveled

at least three hours.

* If they went to higher-volume hospitals, overall travel times

would increase -- but only modestly if they went to hospitals meeting

low- or medium-volume standards. If they went to very high-volume

hospitals, travel time would increase much more substantially.

* To travel to a hospital meeting low-volume standards, about 15%

of patients would need to change hospitals. Most would need to travel

less than 30 additional minutes. About 10% of patients would increase

their travel times by an hour or more; 3% would have to travel three

hours or more.

* About 25% of patients already lived closer to a higher-volume

hospital -- not the top-of-the-line -- so their travel time could even

decrease.

* To get to a very high-volume hospital, about 80% of patients

would need to change hospitals. Of these, more than 50% would increase

their travel time by at least one hour.

Patients living in rural areas accounted for about 15% of Medicare

patients having these procedures. These patients traveled significantly

longer for surgery than patients living in nonrural areas -- even to get

to a low-volume hospital.

To reach hospitals meeting low- or medium-volume standards, travel times

for these patients would not change substantially for either procedure,

Birkmeyer reports.

To reach hospitals meeting very high-volume standards, however, nearly

75% of all patients would travel two hours or more.

" The present findings suggest that low- or even medium-volume standards

could be set for [these surgeries] without imposing unreasonable travel

burdens on most patients, " writes Birkmeyer.

The Center for Medicare and Medicaid Services has set minimum volume

requirements for hospitals where Medicare patients may have certain

transplant procedures.

His findings in this study suggest that a similar policy could be safely

established for other procedures without concern that patients would

have to travel too far, writes Birkmeyer.

SOURCE: Birkmeyer, J. The Journal of the American Medical Association,

Nov. 26, 2003; vol 290: pp 2703-2708.