According to a recent study conducted by Dr. John Finks of the University of Michigan, operative deaths from high-risk procedures have dropped over the last decade. As a Chicago medical malpractice lawyer, I am encouraged by the results of this study. However, digging deeper into the study, this reduction in surgical deaths appears to be largely limited to high volume hospital. In other settings, the rate of death for surgical procedures, including higher risk, does not appear to have dropped and is still unacceptably high.
A surgical error case is a type of medical malpractice case where a patient suffered injury or death because of a medical mistake during surgery. Most surgical error cases involve allegations against a surgeon. However, others medical providers may be guilty of medical malpractice during surgery including surgical nurses, physicians assistants, and intra-operative monitoring technicians. Whether any medical provider is guilty of medical negligence is based on whether that provider complied with the standard of care. The standard of care is what a reasonable medical provider in that field would have done under the same or similar circumstances. Of course, not all surgical deaths are due to malpractice. The Michigan University study does not distinguish between deaths due to medical malpractice and deaths that are not. However, it is reasonable to conclude a reduction in surgical deaths at high-volume hospitals (compared to other facilities) necessarily means the number of malpractice deaths from high risk surgery has also declined.
According to the University of Michigan study, rising hospital volumes appears to be the driving force behind the decrease in deaths for high-risk surgeries. Higher volume facilities are thought to have more experienced and skilled surgeons on staff than other facilities. The study found that higher volume hospitals accounted for 67% of the decrease in mortality for pancreatectomy procedures (which involves the removal of the pancreas). For cystectomy procedures (involving the removal of the urinary bladder), the decrease was 37%. According to the study, one reason for the successful decline in deaths from these higher risk procedures is that they are "relatively uncommon; thus, the financial penalty is minimized for smaller hospitals that refer patients to higher volume centers."
Once again, the good news on reduced death from high risk procedures must be tempered by the fact the reduction is primarily limited to high volume centers. The author of the study cautioned that "although the trend toward safer surgery are encouraging, tens of thousands of patients in the United States still die every year undergoing inpatient surgery." Commenting further, the author noted that "wide variations in outcomes across hospitals suggest further opportunities for improvement."
One area where surgical errors can be significantly reduced in any hospital setting is through the implementation of a surgical checklist in the operating room. Indeed, earlier this year, a Netherlands study found that a simple surgical check-list can prevent one third of medical mistakes . Much like a pre-flight check list for pilots before take off, a surgical checklist provides the surgical team a list of items that must be done and checked off to ensure nothing is missed during surgery. However, many hospitals in the United States still down not require a surgical checklist.
Interestingly, the University of Michigan study adopted the surgical checklist strategy as an effective tool that should be used to reduce the number patient deaths from surgery. The study discussed other important suggestions to increase patient safety. These measures include outcomes measurement, feedback programs, and collaborative quality improvement initiatives. Indeed, all these recommendations can substantially reduce the number of preventable surgical deaths regardless of whether the hospital is a large, high volume center. We can only hope all hospitals will ultimately find the motivation to implement them.
High-Risk Surgery Deaths Down Over Prior Decade, Medpage Today, 6-2-11