Surgical specialty can mean the difference between life and death

A surgeon’s degree of specialization may be a better predictor of whether a patient lives or dies than how many times the doctor performed a procedure, according to new research published in The BMJ.

The study looked at nearly 700,000 Medicare records of patients who underwent  one of eight common procedures over a five-year period. Researchers from Harvard, Dartmouth and the National Bureau of Economic Research, led by Nikhil R. Sahni of the Forum for Growth and Innovation at Harvard Business School, found a surgeon’s specialization level was a major predictor of patient mortality, even after controlling for factors such as staffing ratios and individual hospitals’ financial health.

In fact, according to Sahni and his team, specialization, or the number of times the surgeon has performed the procedure divided by their operative volume for all procedures, predicts mortality better than simply experience. They say specialization can be credited for between 9 percent and 100 percent of the risk reduction commonly attributed to experience.

However, the level of reduced risk varied by procedure; for example, specialization reduced coronary artery bypass mortality risk by 15 percent, whereas it reduced valve replacement risk by 46 percent. Despite this variability, researchers found a clear reduction for six of the eight procedures.

“When selecting a surgeon, patients, referring physicians, and administrators assigning operative workload may want to consider a surgeon’s procedure specific volume as well as the degree to which a surgeon specializes in that procedure,” the researchers wrote.

The study comes in the wake of April research that found seven procedures account for 80 percent of surgical costs and mortality, FierceHealthcare previously reported, with the problem particularly acute at cash-strapped safety-net hospitals.

- here’s the study