Potential benefits of regionalizing major surgery in Medicare patients

Given the strong "volume-outcome" relations observed with many surgical procedures, concentrating surgery in high-volume hospitals could substantially reduce the number of surgical deaths. We explored the potential benefits of regionalizing 10 high-risk procedures for the 38 million Americans enrolled in Medicare.

Number of lives saved in 1 year.

Current number of deaths occurring with each procedure multiplied by the average mortality reductions that plausibly could be achieved with regionalization.

The current number of surgical deaths was obtained from the 1995 MEDPAR file of the Medicare claims database. Expected mortality rate reductions with regionalization, estimated from published volume-outcome studies, were tested over a wide range in sensitivity analysis.

Of 381,000 Medicare patients undergoing any 1 of the 10 procedures in 1995, approximately 17,000 surgical deaths occurred. The total number of lives saved by regionalization depends on assumptions about the mortality reductions likely to be achieved, varying from 853 (5% reduction) to 4266 (25% reduction). Regionalizing common, intermediate-risk procedures (e.g., cardiovascular procedures) would save far more lives than regionalizing less-common, higher-risk operations (e.g., major cancer resections).

Even with conservative assumptions about reduction in surgical mortality likely to be achieved, the benefits of regionalizing major procedures in Medicare patients could be substantial. Policymakers should focus on common procedures before less-common, high-risk operations.