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Hospital report

Surgery quality varies widely in US

The report found that higher-quality, higher-volume services let patients pay less and leave quicker. Photo: Flickr/Fotos Gov BA
Best hospitals are safer, quicker and cheaper than the worst
Cost and provision varies widely over US
Study looked at 478 centres in 19 states

Bariatric surgery is quicker, safer and cheaper in higher-quality hospitals, but US care provision varies widely, according to a new report.

The report, “Choosing Bariatric Surgery to Improve Overall Health”, examined the outcomes of 201,821 bariatric operations between 2008 and 2010, and found that while bariatric surgery was generally safe, there was a large amount of variation between levels of service offered by hospitals around the country.

The paper also reported that bariatric procedures in the 478 hospitals included in the study dropped by 6.39% over the three years, from 69,724 procedures in 2008 to 63,868 procedures in 2010. It reported on a total of 201,821 operations.

5,788 complications that could have been avoided if the worst-performing hospitals had performed as well as the best

The report, published by health care provider rating company HealthGrades, measured results from 478 hospitals in 19 states, rating them as five-star, three-star or one-star locations. They found that patients in five-star programmes were 72.26% less likely to experience an in-hospital complication than patients at one-star programmes.

HealthGrades say that their hospital ratings are independently created; no hospital can opt in or opt out of being rated, and no hospital pays to be rated.

The in-hospital average complication rate for one-star hospitals was 11.79%, compared to 3.03% for five-star hospitals. HealthGrades calculate that 5,788 patients in their study could have avoided a complication if the one-star centres had performed at the same level as the five-star centres.

1.88 Average length of stay in best-performing hospitals, measured in days 2.37 Average length of stay in worst-performing hospitals, measured in days

Patient volume also had a significant effect on complication rate: 7.99% of procedures in hospitals that performed under 75 operations in the three-year period suffered from a complication, compared to 5.71% of patients in centres performing over 375 operations in three years.

Patients had an average stay of 1.88 days after their operation in five-star programmes, half a day less than the average 2.37-day stay in one-star programmes.

One-star hospitals charged on average $3,189 more than five-star programmes, a fact that the report suggested may be due to the higher rate of complications in the poorer-quality centres.

Geographical differences

Cost and provision of bariatric surgery differed dramatically across the 19 states that were studied. The most inpatient procedures were performed in California, New York, and Texas, with 19.25%, 12.85% and 11.86% of the total procedures respectively. Collectively, Iowa, Utah and Rhode Island performed less than 3% of inpatient procedures.

Massachusetts and North Carolina showed large increases in the number of inpatient bariatric procedures, with an increase of 29.7% (3,771 to 4,891) and 24.65% (2,974 to 3,707) respectively; meanwhile, Arizona, Rhode Island and Virginia experienced declines in the number of inpatient bariatric procedures, with drops of 31.61% (2,249 to 1,538), 30.87% (554 to 383) and 30.23% (3,166 to 2,209) respectively.

The most expensive state to receive a bariatric operation in was found to be California, where the average charge was $56,744 for a laparoscopic procedure and $69,963 for an open procedure; meanwhile, a laparoscopic procedure in Maryland cost on average $15,631 and an open procedure $18,406.

The study found that the average cost for a laparoscopic procedure was $41,594, and $45,137 for an open procedure.

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