High Volume Linked to Lower Costs

The researchers reviewed statewide hospital data from New Jersey, New York, and Florida during the 1990s. The analysis included nearly 267,000 patients undergoing six different types of operations for colon and rectal cancer, lung cancer, esophageal cancer, and pancreatic cancer. For each operation, the hospitals and surgeons were divided into thirds, based on the volume of procedures performed.

For all six procedures, the costs of surgery were lower for patients treated by high-volume surgeons. Throughout the study period, costs for patients undergoing pneumonectomy for lung cancer were 5.5 percent lower when the operation was performed by high-volume surgeons (in the highest third), compared to low-volume surgeons (in the lowest third). For esophageal cancer surgery, costs were 10.6 percent lower for high-volume surgeons.

For the other four operations, costs were lower for high-volume surgeons during more recent time periods - from the mid- to late 1990s. The difference in costs was least for colon cancer surgery, 4.4 percent; and greatest for pancreatic cancer surgery, 25.6 percent.

The volume of cancer surgeries performed at different hospitals had no major impact on costs. The exception was colon cancer surgery, which was 1.7 percent less costly at high-volume hospitals.

Several studies have shown that surgeons performing a higher volume of cancer surgeries achieve better outcomes, including lower mortality rates. However, the relationship between volume and costs has been unclear - it may be
that patients treated by more experienced surgeons have lower complication rates, and thus spend less time in the hospital.

The new results suggest that, at least for the six procedures studied, cancer surgery is less expensive when performed by high-volume surgeons. Surgeons may "learn by doing," thus improving patient care and lowering hospital costs.

MEDICA.de; Source: Wolters Kluwer Health