Common surgeries can turn deadly at ‘low volume’ hospitals

When you head in for knee replacement surgery you expect plenty of pain… lots of swelling… and a long recovery ahead of you.

The last thing you expect is to die on the table.

But if you have your surgery performed at the wrong hospital, you could increase your chances of dying by 2,000 percent or more.

That’s the shocking conclusion from a new analysis of “low volume” hospitals that are regularly performing surgeries they’re not qualified to handle.

Some of the nation’s leading hospitals and surgeons are trying to stop the practice for good. And they’re offering an insiders’ look at questions you need to ask before ever letting a surgeon wheel you into an operating room.

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Practice makes perfect
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U.S. News and World Report spent over a year analyzing more than 5 million Medicare records from 4,000 hospitals across America.

And they found that the hospital you choose — even for common surgeries like a joint replacement or a heart bypass — is a life-or-death decision.

For example, if you have your knee replaced at Sterling Regional Medical Center in Colorado, your risk of dying is 24 times higher than the national average.

For a hip replacement, the risk is three times higher.

That’s because Sterling Regional — a small, 25-bed hospital — is what medical experts call a low-volume facility. Its surgeons may perform so few procedures per year that it’s nearly impossible to maintain their skills.

Many of the hospitals studied by U.S. News were performing just a few bypass or joint replacements a year. Patients often don’t realize that the hospitals they’re choosing are so inexperienced until it’s too late.

Dr. John Birkmeyer, a surgeon and chief academic officer at Dartmouth-Hitchcock Medical Center in New Hampshire, crunched the U.S. News data and calculated that 11,000 deaths could have been prevented during a three-year period if patients had gone to higher-volume hospitals.

And he was just looking at five very common surgeries. The real number is likely astronomically higher.

The problem is that hospitals allow their surgeons to perform every type of procedure and technique they’ve been trained on — even if they have almost no actual experience or haven’t done the surgery in years.

And those risks aren’t just confined to small community hospitals, either.

Dr. Birkmeyer said he’s seen it in his own health-care system, where surgeons perform procedures they don’t specialize in “just because it showed up on their doorstep.”

His hospital, along with Johns Hopkins Medicine and the University of Michigan, is trying to change that. They want to ban docs and affiliated hospitals from doing certain operations unless they have a lot of procedure-specific practice under their belt.

In the meantime, Dr. Birkmeyer and other experts are offering some good questions to ask of your doctor and hospital before agreeing to a surgery.

For example:

• How many times has the surgeon done that specific procedure in a year? Dr. Birkmeyer said that for heart bypass surgery, he would want a doctor who does at least 100 a year. For a hip or knee replacement, at least 50 a year.
• What is the hospital’s and doctor’s surgical infection rate? In many cases, it’s a preventable post-surgery infection that threatens patients’ lives.
• How experienced is your surgeon with the specific approach or device he plans on using on you? A doctor who’s a pro at big-incision stomach surgery may still be a newbie when it comes to laparoscopic, or keyhole kinds.

Click here to find the U.S. News hospital rankings, as well as an online search function to check your medical center for experience in five common procedures and conditions. If you want to see how your hospital rates in volume, scroll down to the middle of the page to where it says “by procedure or condition.”