Featured Research

from universities, journals, and other organizations

Minimally invasive surgery underused at many U.S. hospitals

Date:
July 8, 2014
Source:
Johns Hopkins Medicine
Summary:
Hospitals across the country vary substantially in their use of minimally invasive surgery, even when evidence shows that for most patients, minimally invasive surgery is superior to open surgery, a new study shows. The finding represents a major disparity in the surgical care delivered at various hospitals, the study’s authors say, and identifies an area of medicine ripe for improvement.

Marty Makary, M.D., M.P.H.
Credit: Johns Hopkins Medicine

Hospitals across the country vary substantially in their use of minimally invasive surgery, even when evidence shows that for most patients, minimally invasive surgery is superior to open surgery, a new study shows. The finding represents a major disparity in the surgical care delivered at various hospitals, the study's authors say, and identifies an area of medicine ripe for improvement.

Related Articles


The study will appear in the journal BMJ.

"Some surgeons specialize in complex open operations, and we should endorse that expertise," says Marty Makary, M.D., M.P.H., a professor of surgery at the Johns Hopkins University School of Medicine. "But we think there could be a better division of labor at hospitals. Patients who need an open procedure could be sent to surgeons skilled in open surgery. Those who are candidates for minimally invasive surgery could be directed to a surgeon with minimally invasive skills, sparing more patients the risks associated with open surgery."

Minimally invasive surgery, which uses a few small incisions rather than one large incision, has been associated with better outcomes than open surgery, including fewer surgical site infections, less pain and shorter hospital stays. However, says Makary, his analysis shows that some hospitals capable of performing minimally invasive surgery aren't providing it as often as they could.

To measure use, Makary and his colleagues collected data from the Nationwide Inpatient Sample, one of the largest inpatient care databases in the United States. This resource contains information about more than 7 million hospital stays, including the characteristics of each patient, their conditions and their treatments.

The Johns Hopkins team analyzed the data to identify how many minimally invasive surgery procedures hospitals could be performing based on standard qualifications for four different operations: appendectomy, colectomy and hysterectomy, all procedures for which minimally invasive surgery has shown significant advantages over open procedures, and lung lobectomy, an operation for which the jury is still out on the risks versus benefits. The team then compared those numbers with the number of operations actually performed with minimally invasive surgery.

Though all of the 1,051 hospitals included in the data had similar patient characteristics for these procedures, indicating minimal differences in patient candidacy rates for minimally invasive surgery, the researchers' findings show considerable variability in what proportion of these operations were actually minimally invasive surgery. For example, 71 percent of appendectomies could be performed by the minimally invasive operation, but one-quarter of U.S. hospitals favored the open operation for the majority of cases. Hospitals more likely to perform minimally invasive surgery tended to be large urban teaching hospitals located in the Midwest, South or West.

Makary and his colleagues attribute much of the variability to differences in physician training at various hospitals across the country. Since physicians tend to stay and practice in the same region where they trained, Makary explains, whatever techniques surgeons trained in most heavily during their residencies tend to become the go-to procedures that surgeons in particular regions prefer to perform. Surgeons may be uncomfortable offering their nonpreferred method to patients.

Another researcher who participated in the study, assistant surgical resident Michol Cooper, M.D., says underuse of minimally invasive surgery is a problem, because the complication rates for minimally invasive surgery are significantly lower for so many operations. For example, when she and her colleagues used the database to compare complication rates between minimally invasive surgery and open surgery in the four procedures, they found that minimally invasive appendectomies had about one-half the complications of open appendectomies. Similarly, minimally invasive colectomies -- removal of all or part of the colon -- had about one-third the complication rates of open procedures. Consequently, Cooper says, performing as many of these procedures using minimally invasive surgery techniques as possible could help patients stay healthy and save thousands of dollars per patient in medical costs.

Makary says many patients aren't aware that a minimally invasive surgery option exists for their condition. He also believes that this study offers an opportunity to reduce practice variation and improve health care quality through increased transparency and patient empowerment.

"Without any publicly reported metrics, patients can't really know what to look for and what to ask," he says. "Physicians have an obligation to inform patients about all their options, even if we don't offer all the options ourselves."


Story Source:

The above story is based on materials provided by Johns Hopkins Medicine. Note: Materials may be edited for content and length.


Journal Reference:

  1. M. A. Cooper, S. Hutfless, D. L. Segev, A. Ibrahim, H. Lyu, M. A. Makary. Hospital level under-utilization of minimally invasive surgery in the United States: retrospective review. BMJ, 2014; 349 (jul08 8): g4198 DOI: 10.1136/bmj.g4198

Cite This Page:

Johns Hopkins Medicine. "Minimally invasive surgery underused at many U.S. hospitals." ScienceDaily. ScienceDaily, 8 July 2014. <www.sciencedaily.com/releases/2014/07/140708185653.htm>.
Johns Hopkins Medicine. (2014, July 8). Minimally invasive surgery underused at many U.S. hospitals. ScienceDaily. Retrieved November 26, 2014 from www.sciencedaily.com/releases/2014/07/140708185653.htm
Johns Hopkins Medicine. "Minimally invasive surgery underused at many U.S. hospitals." ScienceDaily. www.sciencedaily.com/releases/2014/07/140708185653.htm (accessed November 26, 2014).

Share This


More From ScienceDaily



More Health & Medicine News

Wednesday, November 26, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

From Popcorn To Vending Snacks: FDA Ups Calorie Count Rules

From Popcorn To Vending Snacks: FDA Ups Calorie Count Rules

Newsy (Nov. 25, 2014) — The US FDA is announcing new calorie rules on Tuesday that will require everywhere from theaters to vending machines to include calorie counts. Video provided by Newsy
Powered by NewsLook.com
Daily Serving Of Yogurt Could Reduce Risk Of Type 2 Diabetes

Daily Serving Of Yogurt Could Reduce Risk Of Type 2 Diabetes

Newsy (Nov. 25, 2014) — Need another reason to eat yogurt every day? Researchers now say it could reduce a person's risk of developing type 2 diabetes. Video provided by Newsy
Powered by NewsLook.com
Madagascar Working to Contain Plague Outbreak

Madagascar Working to Contain Plague Outbreak

AFP (Nov. 24, 2014) — Madagascar said Monday it is trying to contain an outbreak of plague -- similar to the Black Death that swept Medieval Europe -- that has killed 40 people and is spreading to the capital Antananarivo. Duration: 00:42 Video provided by AFP
Powered by NewsLook.com
Are Female Bosses More Likely To Be Depressed?

Are Female Bosses More Likely To Be Depressed?

Newsy (Nov. 24, 2014) — A new study links greater authority with increased depressive symptoms among women in the workplace. Video provided by Newsy
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
 
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:  

Breaking News:

Strange & Offbeat Stories

 

Health & Medicine

Mind & Brain

Living & Well

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:  

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile iPhone Android Web
Follow Facebook Twitter Google+
Subscribe RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins