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Hospitals Set New Restrictions On Who Can Perform Risky Surgeries


Knee replacements aren't usually associated with death. The national death rate from the procedure is about one in a thousand. But patients are three times more likely to die if they have a knee replaced at a hospital that doesn't regularly perform the surgery. Now three leading medical institutions are putting restrictions on surgeons. Patient advocates hope other hospitals will follow. But surgeons themselves are skeptical, as New Hampshire Public Radio's Jack Rodolico reports.

JACK RODOLICO, BYLINE: So how bad can things get? Dr. John Birkmeyer at Dartmouth-Hitchcock in New Hampshire says a patient came to him after bariatric surgery at a small hospital, a hospital that didn't perform that operation often. Before sewing up this patient, the surgeon had messed up the plumbing. This patient's gut flowed in a circle.

JOHN BIRKMEYER: Well, the food would come in through the esophagus, go down through a loop of intestine, and rather than continuing downstream, the food would come backwards, up through another other piece of intestine and back up into the bypass part of the stomach.

RODOLICO: And consider the stats for pancreatectomies. One-third of Medicare patients who have their pancreas removed do so at a hospital that performs that surgery only once or twice each year. Yet, most of those patients would only have to drive an extra 30 minutes to get to a high-volume hospital, and most would be willing to do so. A recent analysis of Medicare data by U.S. News & World Report found low-volume hospitals put patients at risk in a big way. Birkmeyer says that analysis indicates up to 11,000 patients died at these facilities from 2010 to 2012.

BIRKMEYER: Surgeons would never disclose the fact that those risks are function of not just the procedure itself but who's doing it.

RODOLICO: The U.S. News report prompted Dartmouth, Johns Hopkins and the University of Michigan to announce they will stop letting low-volume surgeons perform 10 complex surgeries - knee and hip replacements, some cancer and thoracic operations and bariatric surgery. For the most part, these aren't emergency procedures. The 30-or-so years of data suggesting risky surgeries are way riskier in the hands of some - it all really ticks off a lot of surgeons. Dr. Tyler Hughes, a surgeon in rural Kansas, has seen this play out online where he moderates a social media platform for the American College of Surgeons, a trade association.

TYLER HUGHES: I think there's a lot of work going on trying to, if you'll pardon the pun, cut away that cowboy mentality because ultimately, this isn't about us, the surgeon. It's about the patient.

RODOLICO: Bruised egos aside, here's another question. Just because you're licensed to do a surgery, should you? As in, doesn't this call into question the way surgeons are certified?

FRANK LEWIS: No, I do not think that.

RODOLICO: Dr. Frank Lewis is the executive director of the American Board of Surgery which certifies 30,000 surgeons. Lewis says all this data, it really reflects on hospitals, not the surgeons who work there.

LEWIS: There has been very, very little data that relates to individual surgeons and how they might differ from each other.

RODOLICO: Yet, Birkmeyer, the doctor who undid the tangled gut, tested this idea too. In one study, he filmed 20 surgeons at work and found high-volume surgeons' hands were fluid and confident while the low-volume docs were herky-jerky. Some patients will always prefer the closest hospital. Still, Birkmeyer says they should have an informed choice.

BIRKMEYER: It's hard for me to imagine a patient that would react poorly to a health system deciding that only experienced, proficient surgeons will be doing operations.

RODOLICO: Dartmouth, Johns Hopkins and the University of Michigan estimate if high-volume hospitals exclusively did the 10 surgeries on their list, it would save 1,300 lives nationwide per year. For NPR News, I'm Jack Rodolico in Concorde, N.H. Transcript provided by NPR, Copyright NPR.

Before joining NHPR in August 2014, Jack was a freelance writer and radio reporter. His work aired on NPR, BBC, Marketplace and 99% Invisible, and he wrote for the Christian Science Monitor and Northern Woodlands.