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Study questions value of some high-volume surgery

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The general assumption for some years has been that higher-volume hospitals produce better outcomes in some surgical procedures and have lower patient-mortality rates. But a new study  in Applied Health Economics and Health Policy questions at least some of that conventional wisdom.

Rice University researchers said that the link between  a high volume of  procedures and good outcomes has been exaggerated. An analysis of data from the American Hospital Association Annual Survey of Hospitals from 2000 to 2011 found that high volume alone does not account for some hospitals’ surgery success, and that  many things can produce good  patient outcomes.

The team studied outcomes for six complex cancer operations that showed a link between high volume and positive outcomes. Previous studies relied on the simplest statistical models to determine the volume-outcome relationship. After using more sophisticated statistical models, they found that only four of the procedures benefited from higher-volume settings.

“If patients are in need of one of these operations, they most likely will rely on advice from their physician on which hospital to get treated at,” said Vivian Ho, study co-author and chairwoman of  health economics at Rice’s Baker Institute for Public Policy and director of the institute’s Center for Health and Biosciences.  “But physicians who consult the medical literature for guidance on where to send their patients may be getting incomplete information. The medical literature may be overemphasizing the role that hospital volume plays in patient outcomes.”

Last year, some  major providers limited procedures could be performed at low-volume hospitals and by low-volume “cowboy” surgeons who do  procedures that they don’t usually perform.

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