New surgery standards could save 8,000 lives

If all hospitals met the quality standards for five high-risk surgeries set by the Washington, DC-based Leapfrog Group (www.leapfroggroup.org), it would save nearly 8,000 lives each year, according to a new study from the University of Michigan (UM) Health System in Ann Arbor.

Leapfrog has set standards for five procedures:

  • pancreatic surgery;
  • esophageal surgery;
  • open-heart surgery;
  • percutaneous coronary interventions (such as angioplasty);
  • abdominal aortic aneurysm repair.

Open-heart surgery alone would result in about 4,000 fewer deaths, and procedures such as angioplasty would see another 3,000 fewer deaths if all patients were treated at hospitals meeting these standards, according to the study, which was published in the June issue of the journal Surgery [135(6):569-575].

"Patients deciding where to undergo elective but high-risk surgery can substantially improve their odds of survival by selecting a hospital that meets Leapfrog safety standards," says John Birkmeyer, MD, George D. Zuidema professor of surgery at the UM Medical School and chair of the Michigan Surgical Collaborative for Outcomes Research and Evaluation.

Using data from the National Inpatient Sample, a random sample of 20% of all hospital discharges in the United States, researchers estimated the number of patients undergoing each procedure and the average mortality rates. They then estimated how many deaths would be avoided if patients were treated only at hospitals that met the new criteria.

Open-heart surgery patients benefit the most

For all five surgeries, an estimated 7,818 lives would be saved if all hospitals met the standards.

The biggest benefit would be for patients undergoing open-heart surgery. Standards require hospitals to perform at least 450 surgeries a year and have risk-adjusted mortality rates below the national average.

If all patients were treated at the hospitals with the highest volumes and the lowest risk-adjusted mortality rates, 4,089 lives would be saved. Fully implementing similar Leapfrog standards for percutaneous coronary interventions would save 3,016 lives.

Full implementation of Leapfrog’s standards may not be feasible for all five procedures, the researchers caution.

Moving all open-heart surgeries and angioplasties to the top hospitals would not be practical because the surgeries are so common. But since pancreatic resection and esophagectomies are rare, it would be possible for patients to be referred to hospitals that meet the standards. Also, any hospital could ensure appropriate patients receive beta-blockers before abdominal aortic aneurysm repair.

"Efforts should be focused on getting patients to the best hospitals as well as improving quality at all hospitals. It is not clear how many hospitals are making efforts to meet the Leapfrog standards for surgery, but there seem to be trends toward fewer patients undergoing high-risk operations in low-volume hospitals. This may reflect early success of Leapfrog and other efforts," Birkmeyer says.