How Does a Hospital Get Better Surgical Outcomes? Practice, Practice, Practice

When it comes to a higher rate of successful surgical outcomes, more appears to be more, according to a new survey of hospital procedures.

The U.S. News & World Report on Hospital Quality says that hospitals that perform a higher volume of certain surgeries save more lives than those with a low volume of those procedures.

Patients who have these surgeries at smaller hospitals that do fewer of them appear to have a greater risk of severe complications and death because the surgical teams involved simply don’t have as much experience doing them.

From 2010 to 2012, as explained on, researchers tracked every hospital in the U.S. that operated on or treated fewer than 25 traditional Medicare inpatients for 20 frequent procedures and conditions. Hospitals where the population is sparse, or “low-volume hospitals,” showed a higher risk of death compared with the highest-volume urban hospitals.

For example, patients who underwent hip replacement surgery at a low-volume hospital had a 77% higher risk of death than someone who got that surgery at a high-volume hospital. The low-volume hospital patients also had a 25% higher risk of readmission because they had complications from the procedure.

The risk of death was double the national average for knee-replacement patients at low-volume hospitals. Their readmission rate was also 25% higher than that of high-volume facilities.

The report is hardly news. A few years ago, Patrick’s newsletter, “Finding the Right Hospital for You,” included a section on how hospitals develop expertise: “The idea is to find the hospital in your area that week in and week out treats lots of patients just like you. That hospital will have worked out sets of standard practices to ensure the safest, most comfortable experience for you.” noted that decades of research have linked low volume with greater risk, but a shocking number of hospitals continue to put patients at higher risk because they infrequently perform procedures that are common at other facilities. Urban hospitals routinely perform procedures including elective joint replacement hundreds of times a year, while rural facilities might do a handful.

Annually, at each low-volume hospital, there was an average of only:

  • three hip replacements;
  • four knee replacements;
  • four heart bypass surgeries;
  • four bypass heart surgeries involving valve replacements or repair.

“A clear link has been shown between low-volume hospitals,” according to AboutLawsuits, “doctors who only occasionally treat these types of cases and a higher risk to patients, with a death rate of nearly 1 in 1,000, 24 times the national average.”

Some observers say that as many as 11,000 U.S. deaths might have been prevented during the two-year period the study covered if those patients had gone to higher-volume hospitals with more experienced doctors. Because the report covered only some procedures and conditions, it’s impossible to know how many other deaths could have been prevented, but if the pattern holds, probably tens of thousands.

The lesson is that patients might just save their lives by choosing the right hospital. Sadly, the study found that 1 in 5 would choose a local hospital with a death rate of 18% rather than drive two hours to a regional hospital with a death rate of 3%.

If you are considering or are committed to surgery, ask how many times your procedure is conducted every year at the facility you’re considering. Ask your surgeon how many times he or she does your procedure every year. If it’s not an every-week routine, consider moving on.

For more information on surgical errors, see our backgrounder.

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