Surgeon Volume and Surgical Appropriateness

The body of research supporting a strong relationship between surgical volume and outcomes continues to grow. For example, U.S. News conducted an analysis looking at the volume-outcome relationship and found that large numbers of hospitals continue to do small numbers of procedures and as many as 11,000 deaths might have been prevented from 2010 through 2012 if patients who went to the lowest-volume fifth of the hospitals had gone to the highest-volume fifth. Similarly, a recent study of cancer surgeries by the California Health Care Foundation further points to the relationship between very low volumes of cancer surgeries and poor patient outcomes. This latest research reinforces the early findings of Drs. Birkmeyer, Dimick, and others in the early 2000s. Leapfrog’s new measure builds on that research, along with the pioneering work of physician leaders and researchers from Dartmouth-Hitchcock, Johns Hopkins, and the University of Michigan, to advocate for minimum hospital and surgeon volume standards for the ten procedures listed below: 

  1. Carotid endarterectomy
  2. Mitral valve repair and replacement
  3. Open aortic aneurysm repair
  4. Lung resection
  5. Esophageal resection
  6. Pancreatic resection
  7. Rectal cancer surgery
  8. Hip replacement
  9. Knee replacement
  10. Bariatric surgery for weight loss

The new structural measure challenges hospitals and health systems across the country to hold themselves accountable for minimum hospital and surgeon volume standards known to improve the odds of a safer surgery for their patients. Leapfrog will use 2017 as a fact finding year for these new measures. Hospitals will be scored and publicly reported on these measures in 2018.

Surgical Appropriateness

In 2017, in addition to reporting on new minimum volume standard, hospitals will be asked to report on their implementation of a hospital-wide policy which includes processes aimed at monitoring surgical necessity and preventing overuse of surgical procedures. The new questions are designed to identify the steps hospitals have taken to establish and ensure adherence to their own surgical appropriateness criteria, relying on both clinical guidelines and input from their surgeons. The data collected from hospitals this year will be used by Leapfrog and our national expert panel to inform a surgical appropriateness standard that hospitals will be measured against in 2018.


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