Large-volume medical centers produce best clinical and economic results for complex gastrointestinal surgery

A handful of complicated, high-risk gastrointestinal surgeries are safer and easier on patients -- and pocketbooks -- when performed at medical centers that do the most of them, according to results of a Johns Hopkins study published in the July 1999 issue of the Journal of the American College of Surgeons.

For the study, investigators checked key clinical and economic outcomes for 4,561 consecutive patients who underwent one of five gastrointestinal operations in Maryland from July 1989 through June 1997. Specifically, they measured in-hospital deaths, average length of hospital stay, and average total hospital charges for patients undergoing excision of the esophagus, total gastrectomy (removal of the stomach), total abdominal colectomy (removal of the colon), hepatic lobectomy (removal of a liver lobe), biliary tract anastomosis (reconnecting parts of the bile transport system, or radical pancreaticoduodenectomy (removal of the pancreas head along with an encircling loop of the duodenum), also known as the Whipple procedure.

To assess the role of patient volume and surgical experience on outcomes, the researchers grouped the 51 hospitals studied into four categories based on the number of surgeries performed: minimal (10 or less surgeries per year), low (11-20), medium (21-50), and high-volume (201 or more per year).

Only one hospital, Johns Hopkins, met all the criteria for a high-volume provider, accounting for 1,711, of the 4,561 operations. In contrast, the medium-volume group, consisting of four hospitals, performed 762 procedures. There were seven low-volume hospitals which performed 750 procedures, while the minimal-volume group, consisting of 39 hospitals, performed 1,338.

The statewide in-hospital death rate totaled 8.7 percent, compared to the high-volume center's rate of 2.9 percent. The medium-, low-, and minimal-volume provider's rates were 8.4 percent, 12.7 percent,

Contact: Gary Stephenson
Johns Hopkins Medical Institutions

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