High surgical volume equals better patient outcomes

Standards may evolve to reflect the impact that individual surgeons have on reducing surgical risk.

By Andis Robeznieks, AMNews staff. Dec. 22/29, 2003.

In perhaps the medical equivalent of being on the cover of both Time and Newsweek, John D. Birkmeyer, MD, managed to get reports relating to the effect of surgical volume on patient outcome in both the Journal of the American Medical Association and the New England Journal of Medicine during the same week.

Dr. Birkmeyer said he hoped the studies and the publicity they received would help end any arguments about whether there is a relationship between surgical volume and patient outcome, and that patients, health plans and referring physicians would use this information when deciding where surgeries should be performed.

The NEJM report indicated that surgeon volume may be more significant than hospital volume, something Dr. Birkmeyer said might affect health care purchasing strategies of employer organizations such as the Leapfrog Group.

Meanwhile, the JAMA study indicated that referring patients to regional, high-volume centers for certain cancer surgeries would not significantly increase travel times for patients or families.

"The debate should really move past whether the impact of volume is real or not," Dr. Birkmeyer said. "Maybe there is less impact on certain procedures, but it's ridiculous to assert that it doesn't matter."

He said primary care physicians should have a clinical sense of when volume matters and when it doesn't.

This information could be comforting for patients who are especially anxious about upcoming surgery and are looking to lower risks, he said.