Major health providers place limits on low-volume 'cowboy' surgeons to stop patient deaths

Health providers are cracking down on surgeons who put patients at risk by conducting surgical procedures that they don't usually perform.

Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire, Johns Hopkins Medicine in Baltimore and University of Michigan hospitals now place limits on 10 complicated procedures that are exponentially more dangerous when performed by surgeons whose skills are rusty, according to U.S. News & World Report.

"It's a promising, bold move. I hope other hospitals across the country follow," said Leah Binder of the Leapfrog Group, a consortium of U.S. employers and patient advocates who strive to make hospitals safer and to increase transparency between healthcare providers and patients.

The 10 procedures include knee and hip replacements, cancer and thoracic operations and bariatric surgery.  Most hospitals authorize surgeons to perform any procedures that fall within the scope of their training, even if they only perform one such operation per year, New Hampshire Public Radio (NHPR) reported.

But patient outcomes are significantly worse when these operations are carried out by providers who are out of practice or in facilities that rarely handle such cases.  

John Birkmeyer, M.D., at Dartmouth-Hitchcock told NHPR about a patient who arrived at his practice grievously ill from a botched bariatric procedure. An inexperienced surgeon had sewn the patient's alimentary tract into a circle.

A research project by Birkmeyer and U.S. News found that "11,000 deaths nationally might have been prevented from 2010 through 2012" if patients had only gone to a higher-volume hospital and had their procedure done by a surgeon with more experienced hands. 

Surgeons, however, are outraged that anyone would attempt to infringe upon their freedom to perform any procedure they've ever studied. Kansas surgeon Tyler Hughes, M.D., told NHPR that he has seen considerable backlash against the limitations on the Internet message board he moderates for the American College of Surgeons.

"I think there's a lot of work going on trying to, if you'll pardon the pun, cut away that cowboy mentality," said Hughes. "Because ultimately this isn't about us, the surgeon; it's about the patient."

Meanwhile, a  recent report from American College of Surgeons National Surgical Quality Improvement Program found that having doctors in training present during surgeries had no ill effects on patient outcomes. However, these new doctors were always under the supervision of a more experienced surgeon.

To learn more:
- read the U.S. News & World Report study
- here's the NHPR article
- check out the report announcement

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