Surgical Outcomes Depend on a Host of Variables
Studies show experience, hospital volume, race and location all matter
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(SOURCE: Digestive Disease Week, news release, May 21, 2008)
WEDNESDAY, May 21 (HealthDay News) -- New studies show that numerous factors -- such as the number of operations done by a surgeon or at a hospital -- affect patient outcomes for various surgical procedures.
The findings were to be presented Wednesday at the Digestive Diseases Week 2008 meeting, in San Diego.
"Past research has indicated that success rates for procedures are influenced by the volume of that procedure performed at a center. As researchers and medical professionals, we are constantly striving to understand the factors that determine whether a patient has a successful outcome," Dr. Marcia R. Cruz-Correa, an associate professor of medicine and biochemistry at the University of Puerto Rico, Comprehensive Cancer Center, said in a prepared statement.
"The research presented [at the meeting] sheds new light on our understanding of the influences of high-volume vs. low-volume hospitals or surgeons, as well as the influences of demographics such as patient's race, location or insurance coverage," Cruz-Correa said.
A University of Michigan Medical School study that examined patient outcomes after liver resection found that death rates were lower when operations were performed by high-volume surgeons at high volume centers. There was no improved survival associated with high-volume centers or high-volume surgeons alone.
In addition, private insurance and elective admission type also significantly decreased the risk of in-hospital death, said the researchers, who examined in-hospital death rates among more than 3,000 patients who had liver resections in the United States between 1998 and 2005.
A second study found that hospitals with a high annual volume of patients with inflammatory bowel disease (IBD) had lower death rates among IBD patients who had surgery and had shorter post-surgery stays for patients with Crohn's disease.
Despite caring for patients with more severe disease, these high-volume hospitals didn't have longer patient stays or higher costs, said the Medical College of Wisconsin researchers who analyzed data on more than 140,000 patient discharges.
Hospitals that handled more than 151 IBD patients a year were classified as high-volume, those with 51 to 150 patients were medium-volume, and those with one to 50 patients were low-volume.
Patients who had surgery at high-volume hospitals had one-third the death rate of patients at low-volume hospitals. Patients at high-volume hospitals were also more likely to have surgery.
The differences between high-volume and low-volume hospitals were more pronounced among patients with Crohn's disease than among those with ulcerative colitis. Both conditions are forms of IBD.
The findings suggest a possible role for designated centers for the care of complex, hospitalized IBD patients, said the researchers. They added the first step is further research to determine what hospitals with better outcomes are doing differently and how those measures can be applied to all hospitals.
In another study, University of Cincinnati Medical Center researchers identified ethnic disparities among people seeking treatment for liver transplantation, and found these disparities were associated with socioeconomic status, insurance, geographic location, referral source and delayed referral.
The findings from the analysis of 243 patients evaluated for liver transplantation at the center between 2003 and 2006 indicate that people in certain ethnic groups have to wait longer to get help, even if they have access to it. This puts them at risk for advanced disease.
The study found that black patients were more likely than white patients to have a high Model for End-Stage Liver Disease (MELD) score (56 percent vs. 15 percent) and less likely to have private insurance (6 percent vs. 59 percent).
The high MELD score among black patients suggests a delayed appearance at the transplant center, the researchers said. This means that, despite access to treatment centers, many black patients don't use these centers.
But the University of Cincinnati Medical Center transplant center is public and provides treatment free of charge. When patients were asked why they waited to get treatment, they gave a number of responses: Some weren't aware of the available services; some didn't recognize certain physical symptoms of liver illness; and others were distrustful of health-care facilities for cultural reasons.
"Strategies that focus on delayed treatment -- despite its availability -- need to be addressed in order to eliminate ethnic disparities in liver transplant access," Dr. Guy Neff, medical director of the transplant center, said in a prepared statement.
More information
The U.S. Agency for Healthcare Research and Quality outlines what patients should ask before surgery.
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