Regionalizing some surgical procedures would not result in unreasonable travel burdens on patients

Limiting certain high-risk surgery procedures to hospitals that perform high numbers of these operations could be implemented without making patients travel much farther, according to a new study in the November 26 issue of The Journal of the American Medical Association (JAMA).

"For many surgical procedures, operative mortality [death] rates are substantially lower at hospitals that perform them more frequently," the authors write in background information. "As a result, concentrating selected procedures in higher-volume hospitals is advocated by many. ... Previous analyses suggest that such regionalization policies could avert hundreds, if not thousands, of surgical deaths each year in the United States."

However, many worry that such policies would imply unreasonable travel burdens if patients, especially those in rural areas, were required to travel to higher-volume centers for surgery.

John D. Birkmeyer, M.D., of Dartmouth-Hitchcock Medical Center, Lebanon, N.H., and colleagues used national Medicare claims data and U.S. road network information to assess the travel time implications of setting minimum volume standards for two surgical procedures - pancreatic resection (removal or all or part of the pancreas) and esophagectomy (partial or total removal of the esophagus). Data were analyzed from 15,796 Medicare patients undergoing these two procedures between 1994 and 1999. These procedures were chosen for this study because they are usually scheduled electively and are performed infrequently enough that regionalization (limiting these procedures to certain hospitals) would not affect large numbers of patients, according to the authors. Also, the authors note that surgical death rates with each procedure were 12 percent higher at very low-volume hospitals than at very high-volume centers (16 percent vs. 4 percent for pancreatic resection, 20 percent vs. 8 percent for esophagectomy).

"With low-volume standards (1/year for pancre

Contact: Deborah Kimbell
JAMA and Archives Journals

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