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Referring high-risk surgeries to high-volume
hospitals may save lives but not money

The mission of Operating Room Live.com is providing free information and knowledge for medical and surgical success beginning today about The ER-OR and Operating Room Live online web-site... Policies aimed at referring patients who need high-risk procedures such as coronary artery bypass graft surgery to hospitals that conduct a high volume of such surgeries could save thousands of lives yearly, according to some estimates. However, this approach may not necessarily reduce direct health care costs, finds a study led by John Birkmeyer, M.D., of Dartmouth-Hitchcock Medical Center.

Dr. Birkmeyer and his colleagues examined the economic impact of regionalization from the hospital, payer, and society perspectives. From the hospital perspective, this strategy will primarily redistribute surgical profits from smaller to bigger medical centers. Using data from a cross-section of New England hospitals, they estimated average hospital profits for four surgical procedures. Based on average hospital profits for CABG, a hospital giving up 100 procedures a year to a higher volume hospital would experience a net financial loss of $680,000.

From the payer perspective, prices paid for various health procedures will likely increase in some geographic areas, according to Dr. Birkmeyer, as a result of decreased competition among providers.

From society's perspective, it is uncertain how volume-based referral policies would affect the true cost of providing surgical care. Concentrating selected procedures in a smaller number of high-volume centers could create some financial efficiencies as well as savings associated with better quality of care.

However, there would also be new health care costs. Increasing surgery procedure volume at high-volume centers would require adding capacity (operating rooms and beds) at some facilities. There would be new administrative costs associated with transferring medical information between referring and referral hospitals. Finally, volume-based referral strategies would concentrate more care at teaching hospitals, where care tends to be more expensive compared with smaller non teaching hospitals.

Surgical costs could also increase to the extent that volume-based referral policies create incentives for hospitals to do more procedures. The risk that such policies could increase the use of surgery is highest with procedures performed for discretionary clinical conditions, notes Dr. Birkmeyer. For example, there is a considerable gray area as surgeons decide which patients should undergo CABG for lifestyle-limiting coronary artery disease.

For more details, see "Will volume-based referral strategies reduce costs or just save lives?" by Dr. Birkmeyer, Jonathan Skinner, Ph.D., and David Wennberg, M.D., M.P.H., published in Health Affairs.


hospital operating roomOne of the most common types of hospital operating room surgeries performed in the United States each year is cataract removal. This is partly due to the fact that so many people develop a cataract condition. In fact, over half of the population age-60 and older (approximately 60%) have cataracts; by age 75, over 70% of Americans have cataracts. Fortunately, cataract surgery is one of the safest and most effective operations performed today. Since August is Cataract Awareness Month, and because most of us are likely to be affected by cataracts at some point in our lives, this is an optimal time to become more familiar with this medical condition.


OR LIVE surgery videoHeart Surgery is performed every day in the USA. This is another very common surgery performed every day is coronary bypass or valve repair and replacement surgeries. And even though there is a shortage of donor organs, about 2,000 people had heart transplants.

Years ago, doctors thought heart surgery was a dream. Two major advances in medicine that have made heart surgery possible is the heart-lung machine, which takes over the work of the heart and body cooling techniques, which allows more time for surgery without causing brain damage.

The term Cardiovascular Disease covers a large number of diseases that directly affect the heart and the blood vessel system. It especially affects the veins and arteries that lead to and from the heart. Research has suggested that women who suffer with cardiovascular disease usually suffer from forms that affect the blood vessels. While men usually suffer from forms that affect the heart muscle itself. Other known or associated causes of cardiovascular disease include diabetes mellitus, hypertension and hypercholesterolemia.

Heart disease and strokes are other common cardiovascular diseases. Two independent risk factors that have a major impact for heart diseases, cardiovascular diseases, are high blood pressure and high blood cholesterol.

Now day's heart disease does not have to be a death sentence. There are healthy lifestyle choices that can be made and science has come a long way in the early detection of heart disease.

There is a type of heart surgery, sometimes called CABG ("cabbage"). The surgery reroutes, or "bypasses," blood around clogged arteries to improve blood flow and oxygen to the heart.

The arteries that bring blood to the heart muscle (coronary arteries) can become clogged by plaque (a buildup of fat, cholesterol plus other substances). This can then slow or stop blood flow through the heart's blood vessels, leading to chest pain or a heart attack. Increasing blood flow to the heart muscle can relieve chest pain and also reduce the risk of heart attack.

Surgeons take a segment of a healthy blood vessel from another part of the body, and then make a detour around the blocked part of the coronary artery. An artery may be detached from the chest wall and the open end attached to the coronary artery below the blocked area. Or a piece of a long vein in your leg may be taken. One end is sewn onto the large artery leaving your heart - the aorta. The other end of the vein is attached or "grafted" to the coronary artery below the blocked area.


Information on various surgical procedures, including live pictures of actual operations being performed in the Operating Room - LIVE by doctors & surgeons in hospital operating rooms will be on-the-web soon! While you wait for our live operating room, here are several related medical, surgery, doctor & health links of interest:

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