If you, as a patient, are required to have complex surgery, my advice is to get yourself to a hospital where your operation is performed frequently and select a a surgeon who is experienced in the procedure. To restate the obvious, greater experience yields higher quality results (see: Risks Are High at Low-Volume Hospitals). Now, in an interesting turn of events, some academic medical centers are imposing minimal volume standards on themselves and on their surgeons for selected operations (see: Report: U-M Hospital, other top medical centers aim to reduce low-volume surgeries). Below is an excerpt from the article:
The University of Michigan Health System is one of three major institutions in the nation planning to impose minimum-volume standards on its surgeons, which will eliminate certain procedures unless the hospitals and their surgeons do them often enough to maintain a high enough skill level. According to a U.S. News & World report (see: Hospitals Move to Limit Low-Volume Surgeries), U-M Hospital—along with Dartmouth-Hitchcock Medical Center and Johns Hopkins Medicine— is looking to make the voluntary transition by the end of the year. The report showed that patients who get common procedures done at hospitals that do those surgeries in small quantities are at far greater risk for death and other complications than those that who get them done at hospitals where the surgeries are performed routinely. Justin Dimick, a surgeon at the U-M Hospital, told U.S. News that an experienced surgeon who has done 1,000 colon operations through a big incision may still be a relative novice at laparoscopic colectomies, a minimally invasive approach to colon surgery done through small incisions. "A newly minted gastroenterologist from a major teaching center's surgical residency program might have done 300," he said. The voluntary standards are the first coordinated effort to place limits on hospitals and surgeons. Traditionally they have been allowed to every procedure within the scope of their specialty training, even if only once a year.
Here are some examples of the minimums that are being established by these hospitals with the first number being the minimum number of procedures for the hospital per year and the second the minimum for the surgeon per year: bariatric staple surgery: 40, 20; esophageal cancer resection: 20, 5; lung cancer resection: 40, 20.
I want to applaud this initiative but also mention that are some interesting ramifications of this policy by these three institutions. The first is that these major referral hospitals will have little trouble meeting the minimums they have set for most of the procedures listed. However, by publishing these minimums, they are informing the general public to be careful when selecting a hospital and surgeon for certain surgical procedures. I think that this is very useful information for healthcare consumers to know. However, it can also serve to channel patients to the academic hospitals which serve as regional referral centers. It's some of the smaller hospitals and their surgeons that will be disadvantaged by this policy but for a good reason.
In previous notes over the years, I have raised the topic of hospitals marketing themselves as "centers of excellence." When I googled the terms "hospital" and "center of excellence," I got three million hits. This term has thus emerged for some as a self-declared description which may or may not necessarily be synonymous with high quality. Putting aside the marketing aspects of the term, it also reflects the goal of some hospitals, particularly academic centers, to specialize in some areas. There are financial implications in focusing on a set of highly specialized surgical procedures and excluding others. I can see why from this perspective that hospital executives would want to limit the list of procedures that is offered.