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Survival Rate Is Higher With Doctor Who Conducts High Volume of Operations
Center for Colon and Rectal Surgery

Busy Surgeons Are Good for Patients Survival Rate Is Higher With Doctor Who Conducts High Volume of Operations
By ROBERT TOMSHO Staff Reporter of THE WALL STREET JOURNAL
November 28, 2003 Copyright Wall Street Journal 2003

The volume of operations done by an individual surgeon has a far greater impact on patient mortality than the overall number of surgeries done at a hospital, according to a broad-based new study that looked at a nationwide sampling of 475,000 Medicare patients.

The findings, which involved patients who underwent eight different cancer and cardiovascular procedures, expand upon other recent medical studies that reached the same conclusion for individual surgical specialties.

Hospitals that host the most surgeries have long been believed to be the safest for surgery patients. But even at such facilities, mortality rates vary greatly among surgeons, according to the study, which is published in this week's New England Journal of Medicine.

The researchers found, for instance, that at hospitals that conducted the largest number of aortic-valve replacement procedures, there was a 10.2% death rate among patients operated on by surgeons who conducted 22 or fewer such procedures a year. Among surgeons who did 42 or more such operations annually, the mortality rate was 6.1%.

Based on data from 1998 and 1999, the study looked at surgery patients who either died before they were discharged from the hospital or within 30 days after a procedure.

Lead researcher John Birkmeyer, chief of general surgery at Dartmouth-Hitchcock Medical Center, Lebanon, N.H., said the study shows that patients "need to be mindful of picking a surgeon that does a procedure often." He added that the results indicate that "if our goal is to make care better everywhere, we should look at processes of care under the control of surgeons" rather than just the allocation of resources among hospitals.

Dr. Birkmeyer is a paid consultant for the Leapfrog Group, a coalition of 145 corporations, government entities and other providers of health-care benefits. The group lobbies for improved patient safety and increased consumer access to health-care data.

Arthur Levin, director of the Center for Medical Consumers, a New York advocacy group, called the study "one more piece of evidence that experience matters." But he added that, in most states, individual consumers can't readily find out how many procedures a surgeon has conducted.

Meanwhile, Mark Chassin, a professor of health policy at Mount Sinai School of Medicine in New York who wasn't involved in the study, cautioned consumers against judging surgeon quality on volume alone. "The problem is that this association, while it is certainly reproducible and statistically significant, is still only true on average," he said.

Copyright 2007 Center for Colon and Rectal Surgery, 864 Second Street, Santa Rosa, California 95404 U.S.A. All rights reserved.