The majority of hospitals are still electively performing high-risk procedures without the adequate, ongoing experience to do so.
There has been improvement: a higher percentage of hospitals are meeting Leapfrog's minimum volume standards in 2019 than 2018.
To the credit of rural hospitals, the vast majority do not perform these high-risk surgeries. Those that do are much less likely than other hospitals to meet the volume standard for patient safety.
A sizeable percentage of hospitals have implemented protocols to monitor for appropriateness, potentially protecting patients from getting unnecessary surgeries.
"The good news is we are seeing progress on surgical safety. The bad news is the vast majority of hospitals performing these high-risk procedures are not meeting clear volume standards for safety. This is very disturbing, as a mountain of studies show us that patient risk of complications or death is dramatically higher in low-volume operating rooms," said Leah Binder, president and CEO of The Leapfrog Group. "It's time for hospitals and health systems to upgrade their surgical volume policies. It will save lives."
Safety In Numbers uses final hospital data from the 2019 Leapfrog Hospital Survey, the flagship initiative of The Leapfrog Group. More than 2,100 hospitals participated in the 2019 Survey, representing 70% of U.S. hospital beds. Since 2018, Leapfrog has publicly reported on hospital performance in meetingminimum volume standardsfor safety of eight high-risk procedures.
Of the eight high-risk procedures assessed in the report, esophageal resection for cancer and pancreatic resection for cancer are the two procedures where the fewest hospitals met the volume standard for patient safety – less than 3% and 8% respectively. The procedure for which hospitals were most likely to meet the safety standard was bariatric surgery for weight loss (48%). Additionally, the report's analysis shows that while many rural hospitals are doing the right thing by not performing these procedures, those that continue to do so are not likely to meet the volume standards.
Equally important to achieving minimum volume standards is avoiding unnecessary and unneeded surgeries. In this regard, Survey findings show that 70% of reporting hospitals have in place protocols to ensure appropriateness for cancer procedures. For other high-risk procedures evaluated on the Survey, hospital compliance to ensuring appropriateness ranged from 32-60%, depending on the procedure.
"It is critical that hospitals do not perform surgery when the procedure is not appropriate for the patient," said Binder. "In addition to the increased potential for harm to patients, unnecessary surgeries contribute to the burden of overuse and excess expense in the U.S. health care system."
Binder cited an October 2019 retrospective literature study in JAMAthat found the estimated cost of waste in the U.S. health care system due to overtreatment or low-value care ranged from $75.7 billion to $101.2 billion.
In addition to the report released today, individual hospital results on surgical volumes and surgical appropriateness are freely available and searchable at www.leapfroggroup.org/compare. More information about the importance of minimum surgical volumes for safety are available on Leapfrog's website at www.leapfroggroup.org.
About The Leapfrog Group Founded in 2000 by large employers and other purchasers, The Leapfrog Group is a national nonprofit organization driving a movement for giant leaps forward in the quality and safety of American health care. The flagship Leapfrog Hospital Survey and new Leapfrog Ambulatory Surgery Center (ASC) Survey collect and transparently report hospital and ASC performance, empowering purchasers to find the highest-value care and giving consumers the lifesaving information they need to make informed decisions. The Leapfrog Hospital Safety Grade, Leapfrog's other main initiative, assigns letter grades to hospitals based on their record of patient safety, helping consumers protect themselves and their families from errors, injuries, accidents and infections.