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High surgeon volume linked to lower costs
for Cancer Surgery
Newswise — Hospital costs for
complex cancer surgeries are lower when the
procedures are done by surgeons who perform
a larger number of such operations, reports
a study in the July issue of Medical Care.
The journal is published by
Lippincott Williams & Wilkins, a part of
Wolters Kluwer Health, a leading provider of
information and business intelligence for
students, professionals, and institutions in
medicine, nursing, allied health, pharmacy
and the pharmaceutical industry.
"Patients may receive the
most benefit from high-volume surgeons who
provide higher quality care at lower costs
compared with other surgeon," according to
the new study by Vivian Ho, Ph.D., of Rice
University and Thomas Aloia, M.D., of The
Methodist Hospital, both in Houston.
Drs. Ho and Aloia reviewed
statewide hospital data from New Jersey, New
York, and Florida during the 1990s.
The analysis included nearly
267,000 patients undergoing six different
types of operations for colon and rectal
cancer, lung cancer, esophageal cancer, and
pancreatic cancer.
For each operation, the
hospitals and surgeons were divided into
thirds, based on the volume of procedures
performed.
The study focused on how the
volume of procedures performed by surgeons
affected the costs of hospital care.
Higher-Volume Surgeons
Achieve Lower Costs
For all six procedures, the costs of surgery
were lower for patients treated by
high-volume surgeons.
Throughout the study period,
costs for patients undergoing pneumonectomy
(resection of a lung) for lung cancer were
5.5 percent lower when the operation was
performed by high-volume surgeons (in the
highest third), compared to low-volume
surgeons (in the lowest third).
For esophageal cancer
surgery, costs were 10.6 percent lower for
high-volume surgeons.
For the other four
operations, costs were lower for high-volume
surgeons during more recent time
periods—from the mid- to late 1990s.
The difference in costs was
least for colon cancer surgery, 4.4 percent;
and greatest for pancreatic cancer surgery,
25.6 percent.
In some cases, costs were
also lower for patients treated by
medium-volume versus low-volume surgeons.
The volume of cancer
surgeries performed at different hospitals
had no major impact on costs.
The exception was colon
cancer surgery, which was 1.7 percent less
costly at high-volume hospitals.
Several studies have shown
that surgeons performing a higher volume of
cancer surgeries achieve better outcomes,
including lower mortality rates.
However, the relationship
between volume and costs has been unclear—it
may be
that patients treated by more experienced
surgeons have lower complication rates, and
thus spend less time in the hospital.
The new results suggest that,
at least for the six procedures studied,
cancer surgery is less expensive when
performed by high-volume surgeons. Surgeons
may "learn by doing," thus improving patient
care and lowering hospital costs.
The results may have
important implications for efforts to
control the costs of cancer treatment, which
exceed $200 billion per year in the United
States.
"[T]he economics of cancer
surgery could benefit from encouraging
patients to seek treatment for high-volume
surgeons," Drs. Ho and Aloia write. They
also suggest that residency training
programs for surgeons should provide
trainees with "more mentored experiences" in
cancer surgery, thus shortening the time
until they can practice in a safer, more
cost-efficient way.
About
Medical Care
Rated as one of the top ten journals in
healthcare administration, Medical Care is
devoted to all aspects of the administration
and delivery of healthcare.
This scholarly journal
publishes original, peer-reviewed papers
documenting the most current developments in
the rapidly changing field of healthcare.
Medical Care provides timely
reports on the findings of original
investigations into issues related to the
research, planning, organization, financing,
provision, and evaluation of health
services.
In addition, numerous special
supplementary issues that focus on
specialized topics are produced with each
volume.
Medical Care is the official
journal of the Medical Care Section of the
American Public Health Association. Visit
the journal website at
http://www.lww-medicalcare.com.
About Lippincott Williams &
Wilkins
Lippincott Williams & Wilkins (http://www.LWW.com)
is a leading international publisher for
healthcare professionals and students with
nearly 300 periodicals and 1,500 books in
more than 100 disciplines publishing under
the LWW brand, as well as content-based
sites and online corporate and customer
services.
LWW is part of Wolters Kluwer
Health, a leading provider of information
and business intelligence for students,
professionals and institutions in medicine,
nursing, allied health, pharmacy and the
pharmaceutical industry.
Wolters Kluwer Health is a
division of Wolters Kluwer, a leading global
information services and publishing company
with annual revenues (2007) of €3.4 billion
($4.8 billion), maintains operations in over
33 countries across Europe, North America,
and Asia Pacific and employs approximately
19,500 people worldwide.
Visit
www.wolterskluwer.com for
information about our market positions,
customers, brands, and organization.
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