In the United States, surgical complications cost an average of $25 billion a year. For those who qualify, minimally invasive surgery is a clear solution to this problem. It nearly cuts down the number of surgical complications by half and helps to bring down overall health care costs. A new study has found that despite this clear advantage, there are unsettling disparities in the use of minimally invasive surgeries in hospitals throughout the U.S.
Huge Disparity In American Health Care
Johns Hopkins University researchers calculated the use of laparoscopic surgical procedures at over 1,000 U.S. hospitals in 2010, according to a recent press release. The study was published in the online British Medical Journal and included information based on appendectomy, colectomy, hysterectomy, and lung lobectomy surgeries. These are the four most common minimally invasive procedures done in the U.S. Each hospital was marked as low, medium, or high based on their actual to predicted use of minimally invasive surgery. Through their work, researchers found what Dr. Martin Makary, senior author on the study described as “one of the greatest disparities in American healthcare.”
Hundreds Of Thousands Of Patients Not Given Option
Makary and his team found that, on average, the use of minimally invasive surgery for appendectomy was 71 percent, 28 percent for colectomy, 13 percent for hysterectomy, and 32 percent for lung lobectomy. Overall, however, it remained true that surgical complications were less common with minimally invasive surgery than with open surgery in each category.
What was most salient in the information gathered was the large disparity in nationwide hospital’s use of these four surgical procedures. “Hundreds of thousands of patients are candidates and are getting cut open because that’s the way the surgeon likes to do things. This represents a disparity,” Makary told Medial Daily. For example, it was found some hospitals never performed the minimally invasive surgery, while others used it for more than three quarters of their procedures. The only pattern to be uncovered was that urban hospitals were more likely to perform three of the four procedures, but other than that, no other trends emerged.
What Is Causing This Disparity?
Dr. Michael Tarnoff, chief medical officer for Covidien, explained to Medical Daily that which procedure you are offered is largely dependent on what surgeon you see. “It’s literally that volatile and that random,” Tarnoff said. “I think it's two things. It's value being measured more than volume and then forcing the hand of the surgeon to learn how to deliver that value.” Tarnoff, who is currently teaching surgery at Tufts University School of Medicine in Boston, has been training surgeons in the art of laparoscopic surgery for years. He believes that it’s never too late for these doctors to learn a new skill. “It’s a matter of time and effort and understanding what the needs of the training is,” he said.
According Makary, there is also sometimes a “perverse incentive financially” for not offering ideal candidates minimally invasive procedures. “Some fraction of doctors will settle for second best, or respond to the perverse incentive. From this study we learned that the variation of what’s offered is massive,” explained Makary to Medical Daily.
Solution: Educate The Public And Train Surgeons
Often making a new health care option available to the public is more difficult than the actual developments. Makary insists his study is not evidence that all surgeons need to be forced to perform this type of procedure. “I think it’s fair that some surgeons may not feel comfortable and they may be particularly skilled at open surgery, we should embrace that,” Makary said.
Rather, Makary suggests, three changes be made in order to ensure that patients have the option to choose minimally invasive surgery if they are eligible: better educating patients of their options, better training for surgeons, and transparency of a hospital’s performance. “Right now the public has little information to guide their choices. We can only conclude that many of the patients that are undergoing traditional surgery who are candidates are having the open surgery because they are not aware of the option or the option is not being fairly presented,” he concluded.