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 CostsFor 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 CareRated 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.
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