Major teaching hospitals impose restrictions on low-volume surgeries

Three of the top academic hospital systems in the U.S. plan to limit low-volume surgeries and will no longer allow surgeons to perform procedures unless they have sufficient experience, according to U.S. News & World Report.

Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire, the University of Michigan in Ann Arbor and Johns Hopkins Medicine in Baltimore expect to impose the voluntary standards by the end of the year. This is the first such coordinated move to limit procedures, according to the article, as health systems typically give surgeons and hospitals autonomy to perform almost any procedure within the scope of their training.

The three systems compiled a list of 10 procedures that research shows carry higher mortality risks when carried out by surgeons who only perform them occasionally, including joint replacement, bariatric surgery, lung cancer surgery and esophagus surgery. In the U.S., about 1.3 million people a year undergo the 10 procedures, with 264,000 of them at a hospital that would not meet the standards, according to John Birkmeyer, M.D., a surgeon and chief academic officer at Dartmouth-Hitchcock Medical Center. Birkmeyer helped draft the standards with the help of Peter Pronovost, director of the Armstrong Institute for Patient Safety and Quality at Johns Hopkins University.

The move comes just a day after a U.S. News analysis found patients are at greater risk of death from common procedures at hospitals that seldom perform them. The new standards will apply to as many as 20 individual hospitals. Two major Boston teaching hospitals, Brigham and Women's Hospital and Massachusetts General Hospital, are also considering the standards but need more time for deliberation, according to the publication.

Keith Lillemoe, chief of surgery at Massachusetts General, said the hospital needs to scrutinize the specific volume thresholds before committing. "Everybody I've talked to [at Massachusetts General Hospital] buys the importance of volume related to outcomes, and most of us could live very nicely with the numbers put forth by Peter and John in their proposal," he told the publication. "But this is too fast for us to make a commitment."

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