Researchers at Harvard-affiliated Brigham and Women’s Hospital (BWH) have published a study that for the first time casts doubt on a widely held belief that larger hospitals that see more patients have better surgical outcomes.
The study appears in the February issue of the journal Arthritis and Rheumatism.
Although the study looked only at one type of surgery, total hip replacement, researchers say the findings are significant because they challenge widespread expectations that smaller hospitals won’t provide the same level of surgical care that larger ones do.
“We previously showed that larger hospitals had lower rates of mortality and complications immediately following hip replacement than smaller hospitals, as has been shown, for example, in cardiac procedures,” said Jeffrey Katz, associate professor of medicine at Harvard Medical School and on staff at BWH. “So this study indicates that when we follow patients for a few years after surgery, there are no real differences in outcomes between the high- and low-volume hospitals.”
Katz believes the strategy of some insurers favoring high-volume hospitals would avoid a very small number of immediate postoperative complications, but offer little long-term benefit to surgical patients. Based on his research, Katz believes the practice of insurance companies regionalizing surgical and medical procedures to large hospitals should be reviewed in light of this data.
In the study, 1,553 Medicare recipients who underwent total hip replacement surgery were surveyed to determine their post-operative pain and functional status up to three years after they had the procedure. In general, the patients had excellent pain relief and functional benefit. Researchers found a higher level of dissatisfaction with their overall experience at lower-volume institutions – something researchers think may be linked more to patients’ perceptions rather than the care they actually received. However, the key finding of the study is that patients’ level of pain and functional ability were determined to be the same whether they had surgery at a high- or low-volume hospital.
“Our data also shows that older, less-educated, poorer, and more functionally disabled patients would be disproportionately affected by a strategy that shifts patients out of low-volume hospitals,” said Katz. “These findings argue against a blanket regionalization strategy and suggest that the potential trade-off between having total hip replacement in a small-volume or a large-volume center warrant further analysis.”