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Developing regional centers of excellence can be challenging

One of the trends in surgery over the past few decades has been the development of less invasive alternatives to open surgical procedures of many different types.  This short commentary, out of Temple University School of Medicine in Philadelphia, takes a look at one such procedure–transcatheter aortic valve replacement (TAVR).  Because valve replacement surgery candidates are often elderly and have other medical problems besides the malfunctioning valve, there has been considerable interest in offering a less invasive alternative.  However, it has been found that there is a higher risk of stroke for patients who have undergone TAVR compared with the open procedure.

There is an extensive literature available on the relationship between volume and outcome — generally finding that greater experience (doing more procedures) is associated with better patient outcomes.  This supports the notion that it might be a good idea to develop regional centers of excellence, so that patient volume could be concentrated in a few specialized programs instead of being spread out in smaller numbers at various hospitals in the area.  The authors note that in their market — the Philadelphia metro area — regionalization has NOT occurred, and suggest a few of the reasons why not.

Source: Feldman, A.M., and DiSesa, V.J.  Transcather aortic valve replacement: flattening the cost curve.  JAMA, May 5, 2014.  Full text free here: http://jama.jamanetwork.comarticle.aspx?articleid=1868540    Posted by AHA Resource Center (312) 422-2050, rc@aha.org




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