Unnecessary heart surgeries increase with facility supply

More hospitals are developing heart surgery centers, but new research suggests more catheterization labs lead to more performed heart surgeries, especially when they're not necessary.

The supply of heart surgery centers seems to be directly proportional to percutaneous coronary interventions (PCI) in Michigan, as areas with higher rates of cath labs tend have higher rates of PCIs, according to the University of Michigan's Center for Health Research study.

Researchers also found that 43.4 percent of those PCI procedures were elective. According to the study, elective PCIs should be based on patient preferences because the procedure does not reduce cardiac mortality.

"In these cases, there ought to be a choice between medical intervention and [surgery]," lead study author Marianne Udow-Phillips told The Washington Post. "But what we think happens is, when the patient is in the cath lab, they're on the table, anesthetized, and a surgeon might come out to the spouse and say 'we can take care of this right now,' even though that might be the wrong treatment based on the evidence."

The study did note that the number of cardiac surgeries dropped 19 percent from 1997 to 2008, along with mortality rates, which fell 17 percent, showing that more PCIs don't mean better outcomes. More effective treatment and disease management and behavioral changes, such smoking cessation, are likely driving down the cardiac mortality rates, according to the study.

"The amazing and fantastic news is we've reduced the amount of surgery and mortality," Udow-Phillips said. "The fact that variation in treatment has increased, and almost all of it is due to elective procedures, that's more troubling," he noted.

By making sure elective procedures are performed only after patients understand the risks and benefits, hospitals can keep patients happy and safe, improve quality and lower costs, the study suggested.

Despite correlations between surgery center supply and elective procedures, surgery centers are popping up across the country. For instance, Olean (N.Y.) General Hospital will open its new ambulatory surgery center this month and Winchester (Mass.) Hospital open will its new ambulatory surgery center May 8.

To learn more:
- check out the study (.pdf)
- read the Washington Post article
here's the Olean and Winchester announcements