Posted by Bill Sandweg on 15 November 2021.
“Practice makes perfect.” How often have we heard that old bromide? Perhaps the main reason it has lasted so long is that there is a lot of truth to it. There certainly is when the subject is medical procedures.
When it comes to quality medical care, I am fortunate to live in a big city with a number of excellent hospitals within a short drive. While there are a lot of good things to be said about living in a small town, outstanding surgical care is not one of them. Many surgeries are complex, even the ones we often think of as routine, such as hip or knee replacements. In small hospitals, the surgeon may only do a few of these procedures each year. If that is the case, statistics show that the complication rates go way up, as does the risk of death. Here is an excellent post by U.S. News & World Report on the issue.
All other things being equal, and they rarely are, the more often a surgeon and her operating room team perform a surgical procedure, the better they get at it. This should come as no surprise. We see the same thing across many areas of life. If you have a favorite recipe that you prepare at least a couple of times a month, you can prepare it in your sleep. Not so with the meal that you only prepare once or twice a year. For that one, you have to keep going back to the recipe and even then may get something wrong. You don’t have the same feel for the dish. In team sports, the play you practiced over and over usually comes off more smoothly than the trick play you only practiced once.
Small hospitals in small towns face many challenges. It is hard to make ends meet. They need the big ticket surgeries for which Medicare or a health insurer will pay big dollars. It is a problem for the hospital’s bottom line, if the local patients go off to the big city for their complex surgeries. But the statistics show that going off to the big city where the surgeon does your operation at least 3 or 4 times a week may save your life and, at the least, will reduce the risk of post-operative complications. Try as it might, there is no way the small hospital can give even the world’s greatest surgeon enough surgeries to keep her skills sharp. There just aren’t enough patients or surgeries to do that.
Based on the available data, even a surgeon of average talent will probably over time have better outcomes than a more talented surgeon, who just does not get to do the procedure very often. And, of course, the success of an operation is not solely dependent on the expertise of the surgeon. There is an entire team in the operating room working together to make the surgery a success. There is also the post-operative care team, which is responsible for taking care of the patient and helping her recover safely from the procedure. In my own practice, I have seen a number of cases in which a patient who came through an operation with flying colors, died or was seriously injured as the result of mistakes made during the first 12 hours after the surgery. There are lots of ways to screw up an operation or a patient’s post-operative recovery. As a patient, you want the practiced, well-oiled team that can do its job in its sleep.
To put an even finer point on it, the statistics show that surgeries done mid-week have lower complication rates than those done in the early part of the week when the operating room team and the surgeon are just getting back in the groove. If you can avoid it, you do not want to be in the hospital over the weekend, especially if it is a three day weekend. Bad things tend to happen when the usual crews are off on holiday.
For a lot of people, having the surgery at the local hospital, even with a higher risk of complications or death, is still preferable to driving for hours to the city to get the surgery. That is fine and there are many reasons for making that choice. Just be sure you understand that having your surgery at the local hospital places you at higher risk.
