Does Your Hospital Perform Enough of These High-Risk Surgeries to Be “Good” at Them?

It is a generally accepted principle that the more you practice something the more you improve your performance. The same can be said for surgeons, and according to a new study by healthcare quality advocates LeapFrog, many hospitals fail to comply with the LeapFrog Group’s minimum volume standards for eight high-risk surgeries.

The LeapFrog Group’s Inpatient Surgery Report 2019 states:

“Patients undergoing high-risk surgeries have a higher likelihood of errors, complications and even death at a hospital that performs a lower volume of these procedures…. An analysis by U.S. News showed that as many as 11,000 deaths nationally might have been prevented over a three year period if patients who went to the lowest-volume hospitals had instead gone to the highest-volume hospitals for their procedure. In low volume hospitals, surgeons, nurses, and other staff are not able to hone or maintain the skills that are necessary to ensure good outcomes for their patients. In some cases, the consequences can be deadly.”

LeapFrog set out to identify eight high-risk procedures for which there is a strong volume-outcome relationship and they established minimum hospital and surgeon volume standards for each according to the report. Once LeapFrog established the standards, hospitals participated in a voluntary survey about whether the hospital performs enough of the high-risk procedures, and if they required individual surgeons to demonstrate an adequate volume before they would be permitted to perform the procedure.

Hospital and Surgeon Volume Standards for High-Risk Procedures

Source: 2018 Leapfrog Hospital Survey

Procedure	Minimum Hospital Volume Standard	Min. Surgeon Volume Standard
Bariatric Surgery for Weight Loss	50	20
Carotid Endarterectomy	20	10
Esophageal Resection for Cancer	20	7
Lung Resection for Cancer	40	15
Mitral Valve Repair and Replacement	40	20
Open Abdominal Aortic Aneurysm Repair	15	10
Pancreatic Resection for Cancer	20	10
Rectal Cancer Surgery	16	6

Leapfrog’s hospital survey results show that most hospitals in the survey do not meet the minimum hospital or surgeon standards.

The report also considered surgical appropriateness and how hospitals monitor how necessary a surgical procedure was to avoid the overuse of surgical procedures. Fewer than half of the hospitals in the survey have surgical appropriateness policies in place.

In an article in Modern Healthcare, The American Hospital Association called Leapfrog’s standards “arbitrary.” In a statement, Nancy Foster, vice president of quality and patient safety policy at AHA, said “There remains no definitive research about the exact volumes of procedures at which patient outcomes will improve significantly, which means that any prescribed number of procedures against which a hospital or surgeon are measured is arbitrary.” Foster also mentioned that volume is not the only important measure for safe surgical outcomes.

Asking questions for better healthcare outcomes

Dr. Robert Cima, M.D. of the Mayo Clinic advises patients to ask question of their surgeon before surgery that will make them feel more comfortable about the procedure, and that it makes a difference when patients are involved with the decisions they make about their health care. A few of the questions Dr. Cima recommends patients ask include:

• Are you board-certified to perform this procedure?
• Will it help if I lose weight before the operation?
• Does it matter if I am a smoker?
• What if I have sleep apnea?
• Is there anything we can do to shorten my hospital stay?

Furthermore, considering the Leapfrog report, a patient might ask the hospital how many of the procedures in question have been performed there in the last year, and they might ask their prospective surgeon how many of this procedure they have performed in the last year. The report advises that patients can achieve a better outcome when they choose a hospital and surgeon with adequate experience performing the surgery. When hospitals and surgeons are forthcoming with information about surgical volume and the surgeon’s level of experience with a procedure it empowers patients to make safer decisions about their healthcare.

If you have suffered a serious injury because of a preventable medical mistake, you are welcome to contact the New Jersey medical malpractice attorney team at Eichen Crutchlow Zaslow, LLP today at 732-384-1331 or complete the contact form on the website to schedule a free consultation. We have offices in Edison, Toms River, and Red Bank to better serve you.