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Current policy for complex surgery is misguided
March 10, 2004Survival after complex surgery is better not only in hospitals that do a large volume of the same procedure, but also in hospitals that do a large volume of any complex procedure, finds new research.
These findings challenge the policy that patients who need a high-risk procedure travel to hospitals that do a high volume of that procedure (known as regionalisation).
This study will be available on bmj.com on Friday 12 March 2004.
Researchers examined the number of deaths within 30 days of five complex surgical procedures in relation to volume of the same procedure and volume of the other four procedures.
During the five year study period, 31,632 patients had one of the five procedures. Death rates within 30 days of surgery were lower not only in hospitals that did a high volume of the same procedure, but also in hospitals that did a high volume of different procedures.
The association with the volume of a different procedure was occasionally stronger than with that of the same procedure.
A hospital that does a high volume of any complex procedure is likely to have certain characteristics, such as location in a metropolitan area, and specialised resources that may account for improved surgical outcome, say the authors.
Strategies such as regionalising patients who need a high risk procedure at hospitals that do high volumes of the same procedure are potentially misguided and may further exacerbate inequality of resources between hospitals, they conclude.
British Medical Journal (BMJ)
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