By Kathryn Doyle
NEW YORK (Reuters Health) - People who have colon surgery at high-volume hospitals are more likely than patients at smaller ones to go straight home for recovery without needing special care, according to a large new study.
There are many ways to gauge the success of a surgery. Being able to perform daily activities and get around independently after the procedure is as important as surviving and avoiding complications, senior author Dr. Daniel Anaya told Reuters Health.
Recovery often takes a while after colorectal surgery, and understanding the recovery process is important to making it better, said Anaya, from Baylor College of Medicine in Houston.
"Our goal is to identify what the high-volume hospitals are doing differently from other hospitals that lead to improved outcomes," lead author Dr. Courtney J. Balentine, also from Baylor, said.
"Once we figure out why some hospitals do better than others, we can help every hospital adopt the practices that really work so that all patients get the best outcomes no matter where they have the operation."
The researchers divided more than 1,000 U.S. hospitals into thirds based on how many colon surgeries were performed at each facility in 2008. They called the top tier "high-volume" hospitals and the bottom tier "low-volume."
The surgeries included operations for colon cancer and for non-cancerous polyps or blockages, for instance.
Three quarters of the 280,000 patients included in the study were operated on at high-volume hospitals. They tended to be younger, have higher incomes and have private insurance more often than their low-volume counterparts.
Less than half of all patients had complications following surgery, regardless of where they were treated.
At busier hospitals, 86 percent of colon surgery patients were discharged straight home, compared to 76 percent of those treated at less busy hospitals.
Twenty percent of high-volume hospital patients ended up using home healthcare services and 14 percent went to skilled rehab facilities instead. At low-volume hospitals, the reverse was true: more patients used skilled recovery facilities than home healthcare after surgery.
Heading home after surgery indicates recovery is going well, and most patients prefer to return home as soon as possible, Balentine told Reuters Health.
Previous studies have found patients at high-volume hospitals tend to do better in a number of areas than those at low-volume hospitals, the researchers noted in JAMA Surgery. For instance, a smaller fraction of patients die during the month after surgery at busier hospitals.
Patients have a lot to think about when approaching surgery, Dr. Farhood Farjah, associate medical director of the Surgical Outcomes Research Center at the University of Washington in Seattle, said. He was not involved in the new study.
"People who need to have colorectal surgery should ask their surgeon several important questions," Farjah said, like about the risks and benefits of surgery, ways to mitigate risks and potential alternatives.
They should also ask about typical recovery patterns and what they can do leading up to surgery to maximize their chances of getting home afterward, he told Reuters Health.
"Examples of things to do include stop smoking and increase activity and exercise," he said. "Also, patients should consider what support they have in terms of family and friends in the event that they need care when they go home."
The new results don't mean patients should only choose busy hospitals for their surgeries - skilled surgeons can be found anywhere, Anaya said.
"Just because your surgeon works at a hospital that doesn't do many colorectal procedures, it doesn't mean that your surgeon isn't qualified or won't do a good job," he said. "We just showed that, overall, hospitals with higher volumes of colorectal surgeries tend to produce better outcomes, in regards to the postoperative recovery process."
He and others are in the process of investigating what it is about the infrastructure or process at higher-volume hospitals that leads to better recovery. Once they have figured out the answer, Anaya thinks it will apply to all patients, from young to old and urban to rural. But elderly patients may benefit the most, since they are most likely to end up in rehab facilities.
SOURCE: http://bit.ly/1eLD2SF JAMA Surgery, online January 15, 2014.