Referring high-risk surgeries
hospitals may save lives but not money
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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
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
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.
Heart 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.
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