Issue link: https://beckershealthcare.uberflip.com/i/1173622
47 QUALITY IMPROVEMENT & MEASUREMENT Study casts doubt on 'July effect' in heart surgeries By Mackenzie Bean H eart surgery patients do not demonstrate worse outcomes in July when medical school graduates start their residencies, according to a study published in e Annals of oracic Surgery. To assess whether the "July effect" is a real phenomenon, researchers used data from the National Inpatient Sam- ple to examine outcomes for patients who underwent one of the following procedures at teaching and nonteach- ing hospitals between 2012-14: • Coronary artery bypass graing • Surgical aortic valve replacement • Mitral valve repair or replacement • Isolated thoracic aortic aneurysm Researchers assessed patients' in-hos- pital mortality and complication rates in relation to the month and academic quarter the procedure was done in. ey found risk-adjusted mortality rates did not vary based on when the procedure was performed. Teaching hospitals also demonstrated equivalent — and sometimes better — patient outcomes for heart surgeries. "e July effect is not evident for cardiac surgery despite preexisting notions," researchers concluded. "ese findings highlight the pivotal role of hospital support systems to ensure the safe transition of resident classes without compromising on patient outcomes." n Study: Surgical volume standards not linked to better outcomes for some procedures By Mackenzie Bean H ospitals' adherence to surgical volume standards does not always correlate with better patient outcomes, suggest the findings of a study published in JAMA Surgery. For the study, researchers analyzed Medicare claims data on 516,392 patients who underwent pancreatic, esophageal, rectal or lung resection for cancer between 2005 and 2016. Researchers looked at patients' mortality and compli- cation rates in relation to whether hospitals met The Leapfrog Group's surgical volume standards. There was no statistically significant difference in mortality rates between hospitals that did and did not meet surgical volumes for esophageal, lung and rectal cancer resections. For pancreatic resections, the mortality rate was con- sistently lower at hospitals that met volume standards. Researchers noted surgical volume still plays an important role in patient safety. When researchers compared the hospitals that performed the most surgeries to those that performed the least, they found large differences in patient outcomes. "These findings highlight important tradeoffs between setting effective volume thresholds and practical expectations for hospital adherence and patient ac- cess to centers that meet those standards," researchers concluded. n Physician viewpoint: Hospitals should report minimally invasive surgery rates By Anne-Marie Kommers H ospitals have a moral obligation to publicly release data on how often they opt for minimally invasive surgery, wrote Ira Leeds, MD, and Martin Makary, MD, who are both surgeons at Johns Hopkins Hospital in Baltimore, in an op-ed for U.S. News & World Report. Although minimally invasive surgery often results in fewer wound infections and opioid painkiller prescriptions, some hospitals rarely use the surgery for candidate patients, the authors wrote. They attribute the problem in part to surgeons who prefer a more traditional approach: "It's just how I like to do it" is a common justifi- cation, the authors said. To combat the problem, the authors suggested creating a publicly available com- parison of minimally invasive surgery rates among hospitals. "Now that this data is measurable and the evidence is clear, don't we have a moral obligation to make the data available to people?" the authors wrote, noting that physicians often seek minimally invasive surgeries for themselves. The authors offered a few caveats: Hospitals should only be compared for a subset of operations for which minimally invasive surgery has been shown to be superior. Critical access hospitals, rural medical centers and other facilities with workforce issues should be exempt from the comparisons. n