May 13, 1997
Media Contact: Gary Stephenson
Some complicated, high-risk liver operations are safer, easier on the patient -- and less costly -- when performed at medical centers that do a lot of them, according to a Johns Hopkins study.
Results of the study will be presented May 13 at The Society for Surgery of the Alimentary Tract annual meeting in Washington, D.C.
For the study, researchers analyzed average length of stay in the hospital, cost, death rate and relative risk rate on 606 liver resections (partial removal of the liver) performed at 36 of the 52 Maryland acute care hospitals from January 1990 through June 1996.
Of the 606 operations, 264 or 43.6 percent were performed at a single institution, The Johns Hopkins Hospital, which averaged 41 of the operations per year. In contrast, a total of 342 operations were performed at the remaining 35 hospitals, with an average of 1.5 procedures per institution per year.
Patients were five times more likely to die from liver resection surgeries performed at the other centers compared with Hopkins (7.9% versus 1.5%). Put another way, the adjusted (adjusted for age, race, gender and number of comorbidities) relative risk of dying as a result of liver surgery at Hopkins was 1.0 compared with 5.2 for the other centers. And, while the adjusted average length of stay was slightly higher for patients receiving the surgeries at Hopkins compared with the other health care facilities (11.1 days versus 9.8 days), the adjusted average cost of the surgeries was comparable at Hopkins ($15,435 versus $15,326).
"These findings challenge the current trend in the delivery of health care services that sees many patients being directed away from medical centers that do a high number of complex surgeries toward lower-volume hospitals under the mistaken notion that money will be saved and outcomes won't be compromised," says Toby Gordon, Sc.D., one of the study's authors and Hopkins Hospital vice president. "The study underscores the importance of the role of experience in patient outcomes. There is no substitute for experience."
The other authors of the study are M.A. Choti, M.D., H.M. Bowman, H.A. Pit, M.D., J.A. Sosa, M.D., J.V. Sitzmann and J.L. Cameron, M.D.