Who Will Do My Surgery?
Photo Credit: Gary Minnaert
There are many serious problems in health care. One of the more hidden and dangerous ones is doctors performing surgeries for which they are not properly trained.
In reference to joint replacement, there is a lot of literature concerning the minimal volume of operations that separate surgeons with lower versus higher complications. I know of no US Hospital that requires surgeons to have this volume tie to their privilege to perform this surgery at that hospital.
In a report from Brigham and Women's Hospital (Harvard), for first time (primary) hip replacement, the surgeons who performed more than fifty a year had lower complications.
The same group at Harvard reported on knee replacement volume. Knee replacements done by surgeons who performed more than fifty procedures a year had lower complications an adverse outcomes. Hospitals that performed more than 200 procedures a years had lower complications as compared to hospital that did less than twenty-five procedures.
In another report, patients had higher satisfaction in hip replacement if the surgeon performed more than thirty procedures a year and the hospital performed more than one-hundred.In another report, patients has higher satisfaction in hip replacement if the surgeon performed more than thirty procedures a year and the hospital performed more than one-hundred.
In a report from the VA in Boston, surgeons who performed more than four shoulder replacements a year had lower complications than those who did less than four.
So what can we conclude here?
At the very least, the surgeon you choose should perform a minimum of thirty primary joint replacement procedures a year for you to have an optimal satisfactory result with lower complications. This means:
- Thirty total knee replacements
- Thirty partial knee replacements (unicompartmental)
- Thirty primary total hip replacements
What are you to do? Ask your surgeon. He or she should be able to tell you whether or not they do at least thirty cases. It is not important as to the actual volume. There is no proof that there is a difference in quality between a surgeon who does one hundred or three hundred. In fact, more volume per surgeon after a certain number may beg the question - who is actually performing the surgery (the surgeon, an assistant, a surgeon-in-training)?
You can follow-up the answer with a letter to your surgeon:
Dear Surgeon:
I am pleased to be having surgery with you. As per our discussion you assured me that you perform at least thirty procedures a year of the procedure I am having with you. My decision to have this procedure with you was dependent on this fact. Thank you and I look forward to this procedure.
Signed,
The Patient
What would be the purpose of this letter? It may represent an implied warranty of the accuracy of the information you were given. It will certainly scare the bejesus out of any blatant liars and scoundrels.
Should hospitals should require a minimum of a certain procedure by a surgeon on staff? Absolutely. A reasonable approach is to set the volume standards and give a surgeon a reasonable amount of time to achieve these. This allows new or growing surgeons to reach these volumes. One can say, you need to reach these volumes within three years of you performing the first procedure at this hospital.
Size may not always matter, but it appears that volume does.
Dr. K.
Related Topics:
- WebMD Video: Joint Camp - Preparing for Hip and Knee Replacement Surgery
- WebMD Video: Computer-Guided Knee Replacement
11 Comments:
I was not aware that there was actually data on the number of cases a surgeon does and quality. Does anyone ot there actually ask their surgeon the number of operations he or she does? How do you check if the answer is accurate?
yes, some do ask how many times the surgery or procedure is proformed, I am one of those people but, Im not sure if there is a way to find out if a surgeon has performed as many operations as the say. I have had several surgeries and have always asked until last year. My docoter said my gallbladder needed to come out. He sent me to a surgon. I felt so bad I just wanted it over. I didn't ask until my surgon came to my hospital room to visit late one night after the surgery and began to straighten the pic hanging on the wall so... for lack of conversation, in pain, I asked. To my suprise she said I've been a Dr. for six years and a surgon for six months, and mine you this was not a teaching hosp. You do the math.
Who will do your surgery is an interesting article but numbers are not sufficient for QUALITY.
Remember--GM made max.# of Cars,but Toyota's won on Quality.
Read Harvard's Dr. Groopman's book-"How Doctors think".
He went to three top Ortho.Surgeons who do most surgeries in Massachussetts area for his HAND AILMENT.They all were ready to do surgery in the wrong area.They knew it after quick glance--WRONG WRONG.
The fourth young surgeon listened carefully--asked Groopman to move both his hands--and had a gut that it is an injury that does not let him move his hand--HE HAD X RAYS done with FIST TIGHTLY HELD.
Later the 5th Surgeon saw the problem on the LATEST NEW machine.
YOU NEED TO KNOW the background of the Surgeon--but not whether he has done --how many surgeries?Best trained surgeon has done different variety type of surgeries in famous hospitals under top experts and they are research minded--THEY THINK.
THINKING is an ability that many do not possess adequately--because they have an attitude that I know it.Some are in rush--they DO NOT LISTEN to patient as they have preconceived idea madeup in 2 minutes--COOK BOOK SURGEONS and DOCTORS are in majority--70 to 80% are COOKBOOK DOCTORS.
Dr.Groopman a well known doctor and his wife--went thru this difficulty in choosing the right surgeon--YOU AND I would have tough time.
My suggestion:Find a Doctor or Surgeon who is a good listener and has good credentials--not HOW MANY but QUALITY like when you select a New Car.
I recently had surgery to repair tennis elbow in my right arm. The surgeon I chose told me right off that he had only done this surgery 15 times in his 20 year career. However, he also said that he had a 100% success rate and said the overall success rate for the surgery was around 90-95%. This is not a common surgery since most people get relief from non-invasive treatments.
I am pleased with my outcome. It has been 75 days since the surgery and I have full range of motion and no loss of grip strength. Plus, my tendonitis pain is gone. I agree that experience counts and the only way you get it is to perform the surgery.
This is a very good point. Certain operations are not common so the volume for expertise would be different for each procedure. Additionally many operations share surgical skill so there is overlap.
The volume issue is just one piece of the puzzle. Nothing replaces a caring physician who takes a good history, physical examination and gives serious thought to your specific case.
Doctor K.
Comment on THINKING surgeons:
It is absolutely critical to have a surgeon with the ability to think through your case and spend an appropriate amount of time on your care. One should not estimate the extreme importance of technical skill in surgery. When "anonymous" above commented that surgeons who trained at "famous" hospitals think I believe that misses a critical point. Without the surgical skill ALL the thinking in the world cannot solve move the knife and put the pieces together. You need both.
Doctor K.
This people realy help me.
http://pergola.prohosts.org/
Thx Pergola.
Dr. K.
I am finding most surgeons get tied down to a specific product. In my research I have found(based on my limited knowledge) that either the stryker Triatalon or the smith/depuy(?) Journey Knee are the best. I see you have an affiliation with stryker. How does a patient find the best knee suited for them. What is the difference? Is success more dependent on the surgeon or the device. A lot of hype surrounding the different devices from the manufacturers. Trying to sort thru it all.
Thanks Mike
DEAR DOC;
I WAS INTERESTED IN GETTING SOME FEEDBACK FROM YOU ABOUT MY MOTHERS HIP REPLACEMENT SURGERY THAT WAS DONE A FEW YEARS BACK BUT SINCE SHES BEEN ALMOST TOTALLY INCOMMUNICABLE SHE DOESN'T TALK TO ME ON THE PHONE AND NEVER ANSWERS MY LETTERS. WHAT SHOULD I DO. DO YOU THINK THAT IS NORMAL? ann in oakland
patcanna@yahoo.com
Can you drink a 24oz beer while on Remicade?
this is unrelated but I cannot find any info regarding repairing a broken tibia with pins, plates and screws. A few screw are now showing thru the skin (after surgery 10 months ago) and my surgeon says he will remove everything if I wish. Obviously I would rather not have all of this "hardware" in my leg but - will the strength of the bone be compromised by the eight holes made by the screws that attach the plate to the bone? and would sooner be better than later to have this done??
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