Hospitals in the United States are failing to meet the minimum surgical safety standards for certain high-risk procedures.
In fact, the majority of hospitals in the U.S. fail to meet hospital or surgeon volume standards, deeming them unsafe. This is according to a study from nonprofit organization Leapfrog, a watchdog group for healthcare purchasers.
The report analyzed data from a 2018 survey of more than 1,300 hospitals. Under the guidance of the Armstrong Institute for Patient Safety and Quality at Johns Hopkins Medicine, experts at Leapfrog made these discoveries:
Few Hospitals are Meeting Standards
Leapfrog reviewed eight high-risk surgeries, including bariatric surgery, three cardiac procedures and four cancer-related surgeries. The study found only 3% of the 1,326 reporting hospitals met a minimum of volume standards for cancer-related esophageal resections and open abdominal aortic aneurysms.
Here are the percentages of hospitals that fully met the Leapfrog Standard (which complies with the hospital and surgeon minimum volume standards):
- Bariatric surgery for weight loss: 38%
- Carotid Endarterectomy: 16.2%
- Esophageal resection for cancer: 2.6%
- Lung resection for cancer: 5.6%
- Mitral valve repair and replacement: 7.1%
- Open abdominal aortic aneurysm repair: 2.5%
- Pancreatic resection for cancer: 5.4%
- Rectal Cancer Surgery: 5.6%
Rural hospitals met none of the minimum standards for five of the eight high-risk procedures.
Fewer than One-Third of Hospitals Have an Appropriateness Policy in Place
Leapfrog discovered most hospitals do not have adequate criteria for gauging whether high-risk procedures are appropriate for patients, which could lead to overuse of these procedures, researchers said. Bariatric surgery fared the best with 44% of reporting hospitals claiming they have a standard in place for judging whether weight loss surgery meets standards, likely linked to more stringent standards put in place by the payers.
"This is deeply concerning and it’s enough of a problem that we believe hospitals should put in place at least a minimum policy to try and assure patients undergoing these serious surgeries are in fact needing them,” says Leah Binder, president and CEO of Leapfrog, in an article for FierceHealthcare.
According to Binder, research shows the volume of procedures performed is associated with better outcomes, and no hospital or surgeon should perform fewer than one or two of these procedures per year.
What Can Healthcare Organizations Do?
According to the study, several hospitals declined to report whether they have an appropriateness evaluation standard in place, or provide any information detailing the number of these high-risk surgeries they perform.
To increase patient confidence, hospitals should implement extra measures to meet surgical safety standards, and put an appropriateness policy in place and make this information public