Study Finds Better Survival Rates at ‘High-Volume’ Hospitals

A growing number of studies suggest that when it comes to surgery, practice makes almost perfect. The latest study shows that patients who had a type of cancer surgery were less likely to die or have complications if their hospitals performed many of the procedures.

In a study in Cancer released today, doctors compared cancer patients who had their bladders removed at “low-volume” hospitals, where surgeons performed three such surgeries a year, with “high-volume” centers that did at least 10. In the first two weeks after surgery, 3.1% of patients at low-volume centers died, compared with 0.7% at high-volume hospitals. In the study, all of the high-volume hospitals were teaching hospitals associated with medical schools. Nearly 16% of patients at low-volume centers had complications, compared with 9% of those who went to more experienced centers.

More than 63,000 Americans are diagnosed with bladder cancer every year, and about 20% have this type of surgery, says author Linda Elting, a professor and chief of health services research at M.D. Anderson Cancer Center in Houston.

Some health experts recommend that insurance companies refer patients who need complex surgeries to high-volume centers. Elting notes, however, that this could force patients in rural areas to travel hundreds of miles. In the study, in which she studied 1,300 Texas patients, Elting found that only two cities in the state had hospitals that performed more than 10 bladder removals a year.

But researchers also found that patients do best at hospitals where registered nurses care for a small number of patients. Elting suggests that patients might select hospitals with the best nurse-to-patient ratios.

Even patients at high-volume hospitals fare better if they choose surgeons who perform the most procedures, says John Birkmeyer, a University of Michigan surgery professor. Relatively few patients, however, are aware of ways to compare the quality of doctors and hospitals, he says.

For patients facing the riskiest surgeries, “doing research and choosing carefully really can mean the difference between life and death,” says Suzanne Delbanco, chief executive officer of the Leapfrog Group, an alliance of companies that promote healthcare quality and safety.

A number of groups are starting to create hospital “report cards” for consumers, says Peter Bach, senior adviser to the administrator at the Centers for Medicare and Medicaid Services. Medicare, for example, runs a website that allows consumers to search for hospitals and see how they compare in several key measures.

Hospitals still release relatively little information, however, says Kenneth Kizer, president and chief executive officer of the National Quality Forum, which focuses on improving health care and patient safety.

“Hospitals need to track their performance,” Kizer says. “Patients have a right, and they should expect that this information will be made available. You expect it when you buy a car.”