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September 25, 1996
EMBARGOED UNTIL 4:00 P.M. EST, WEDNESDAY, OCTOBER 9, 1996
HIGH-RISK GI SURGERY PATIENTS DO BETTER AT MAJOR MEDICAL CENTERS
Patients undergoing high-risk, complex gastrointestinal surgeries are far less likely to die if they are in hospitals that do a lot of them, according to a Johns Hopkins study. Moreover, they won't pay any more for the added safety.
Results of the study will be presented at the American College of Surgeon's annual meeting in San Francisco, CA.
"These results are the latest in a series of related studies that demonstrate the value of major medical centers in providing superior care that is cost-effective as well as the importance of having experienced physicians and staff treat high-risk patients," said Toby Gordon, Sc.D., the study's lead author and Hopkins vice president.
In the study, researchers reviewed hospital discharges for 2,781 patients for six operations performed at 51 Maryland hospitals between 1990 and 1994. In-hospital death rates, average length of stay and average hospital cost per discharge were examined. The average annual number of procedures performed per hospital ranged from less than one to 192. Hopkins did the most -- 960, or 34 percent of the total.
Patients at lower-volume hospitals were at least twice as likely to die while hospitalized than similar patients treated in the highest-volume center, suggesting that major academic medical centers are centers of excellence' for certain conditions," says Gordon, who also is associate professor of surgery.
The operations surveyed are among the most difficult operations performed by surgeons, and include removal of the esophagus, the stomach, and large parts of the liver, as well as biliary tract anastomosis (surgically connecting bile ducts), and radical pancreaticoduodenectomy (removal of the head of the pancreas along with the encircling loop of the duodenum).
According to the Hopkins researchers, the findings have important implications for managed care organizations, other payers and consumers seeking the most cost-effective settings for many high-risk surgical procedures.
"Hopkins studies of the Whipple Procedure (for pancreatic cancer), kidney transplants, craniotomy for brain tumor, and other procedures show that many treatments at academic medical centers are cost-effective and result in better patient outcomes than the same operations at hospitals that do a lower number of the operations," Gordon said.
In the study, the researchers accounted for differences in patient mix and case complexity to ensure valid comparisons. Average length of stay and costs were roughly comparable at the highest-volume center and the lower-volume hospitals.
"While all health care facilities benefited from having increased experience with complex gastrointestinal procedures, the positive effect was most notable at the highest-volume regional center," Gordon added.
Gordon noted that the researchers were aided in their outcomes study by the State of Maryland's unique medical data collection system. "Maryland has one of the most complete hospital admissions databases in the United States," she said. "In terms of having access to data and the availability of true cost data, Maryland is probably unique."
The other authors of the study are Gregg Burleyson, R.N., Soosan Shahrokh, Ph.D., Eric B. Bass, M.D. and John L. Cameron, M.D.
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