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OPERATING ROOMS: How much major surgery is infrequent? Is there an impact on costs?

Texas hospitals were studied to see how many inpatient major surgical procedures were not performed very often (once a month or less) at each hospital analyzed.  In this study of discharge data from 343 hospitals for the period late 2015 to early 2016, over half (54 percent)  of procedures were found to be uncommon (as defined above) for the hospital where they were performed.  These procedures accounted for 68 percent of inpatient costs.

Source: O’Neill, L. and others. (2017, September). Discharges with surgical procedures performed less often than once a month per hospital account for two-thirds of hospital costs of inpatient surgery. Journal of Clinical Anesthesia. 41, 99-103. Click here for publisher’s website: http://www.jcafulltextonline.com/article/S0952-8180(17)30659-1/fulltext   Posted by AHA Resource Center (312) 422-2050, rc@aha.org

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

 

 

 

60% of burn patients admitted to burn centers: U.S.

North Carolina has two burn centers verified by the American Burn Association.  Despite the availability of these resources and a well-established state EMS system, only half of burn victims were found to be admitted to North Carolina’s two verified burn centers during the study period from 2000 to 2007.  This compares with 60 percent nationally.  Interestingly, a commentator on this article cited similar data from a study of burn referral patterns in Florida — about half of burn patients were referred to burn centers.  The North Carolina study also looked at outcomes of the specialized burn centers compared to burn patients in other hospitals.  The burn centers’ median length of stay was 7 days compared to 4 in other hospitals and mortality was higher (7.5 percent compared to 1.5 percent).  The burn centers also were more likely to perform operations on the burn patients.  These outcomes are consistent with the likelihood of having more seriously-injured patients in the specialized burn centers.  Patients treated in hospitals other than the specialized burn centers were found to have a higher percentage of discharges going to skilled nursing facilities.

Sources: 

Holmes, J.H. IV, and others.  The effectiveness of regionalized burn care: an analysis of 6,873 burn admissions in North Carolina from 2000 to 2007Journal of the American College of Surgeons;212(4):487-495, Apr. 2011.

American Burn Association.  Burn Center Verification, [accessed 5/3/11].

Posted by the AHA Resource Center, (312) 422-2050, rc@aha.org