Report: Majority of Hospitals Do Not Perform High-Risk Procedures Enough to Meet Safety Standards

When it comes to performing high-risk procedures, The Leapfrog Group has determined that the majority of hospitals do not meet a minimum volume standard for safety. Safety in Numbers: The Leapfrog Group’s Report on High-Risk Surgeries Performed at American Hospitals analyzed 8 high-risk procedures to determine whether hospitals and surgeons are performing them enough times to minimize the risk of patient harm or death.

The report used data from more than 2000 hospitals and, in addition to assessing volume standards, evaluated whether hospitals had policies in place to assure the appropriateness of each surgery.

The 8 procedures, which were chosen based on review of hundreds of studies over the past decade, and the minimum volume standards are:

• Bariatric surgery for weight loss—a minimum of 50 procedures for hospitals and 20 for surgeons
• Carotid endarterectomy—20 procedures for hospitals; 10 for surgeons
• Esophageal resection for cancer—20 procedures for hospitals; 7 for surgeons
• Lung resection for cancer—40 procedures for hospitals; 15 for surgeons
• Mitral valve repair and replacement—40 procedures for hospitals; 20 for surgeons
• Open abdominal aortic aneurysm repair—15 procedures for hospitals; 10 for surgeons
• Pancreatic resection for cancer—20 procedures for hospitals; 10 for surgeons
• Rectal cancer surgery—16 procedures for hospitals; 6 for surgeons

Open abdominal aortic aneurysm repair and esophageal resection for cancer were the procedures with the fewest hospitals meeting the volume standard (≤3% for each). Hospitals were most likely to meet the volume standard for bariatric surgery for weight loss (38%).

The report highlighted disparities between urban and rural hospitals, with urban hospitals outperforming rural hospitals. The Leapfrog Group noted that there were some instances in which no rural hospitals fully met the volume safety standards.

“No hospital and no surgeon should do only 1 or 2 of these procedures a year ever. The evidence is abundant: that’s not safe for patients,” Leah Binder, president and chief executive officer of The Leapfrog Group, said in a statement. “Sometimes protecting patients means helping patients find a more appropriate place to have their surgery. That’s not always easy, but it’s the right thing to do.”

As for appropriateness, The Leapfrog Group asked hospitals to report on whether they have a hospitalwide policy to monitor surgical necessity and prevent overuse of surgical procedures, as well as progress in developing appropriateness criteria. Again, bariatric surgery for weight loss led the pack, but still only 45.4% of hospitals had a surgical appropriateness policy in place. For the rest of the procedures, fewer than one-third of hospitals indicated having a policy, with open abdominal aortic aneurysm surgery coming in with just 25.6% of hospitals having such a policy.

“It’s clear from this report that patients should be very careful before they choose a hospital for one of these high-risk procedures,” said Binder. “Beyond the disturbing findings in this report, patients should worry even more about hospitals that decline to report this information at all, because candor and transparency is the necessary first step to improvement. We are confident that health system leaders will use these findings productively, in this case by concentrating volume in the most appropriate setting, and monitoring appropriateness better.”