Hopkins' success rate in cancer surgery touted

January 04, 1995|By Jonathan Bor | Jonathan Bor,Sun Staff Writer

WASHINGTON -- Hoping to soften its reputation for high costs, the Johns Hopkins Hospital made a pitch yesterday that it saves both money and lives when performing high-risk surgery on patients with pancreatic cancer.

Hospital officials said their study on the Whipple procedure -- complex surgery on the pancreas -- shows that insurance companies often err when steering patients away from Hopkins in the name of economy.

At a news briefing yesterday, hospital vice president Toby Gordon and surgery chief John L. Cameron said they are conducting similar studies of other dangerous procedures, including operations to repair aneurysms of the chest and abdomen. Preliminary results point to similar conclusions, they said.

Dr. Cameron said the Whipple study supports the long-accepted concept that hospitals with the most experience performing risky operations also have the best success rates. But he said this is the first research to show that, at the same time, large-volume hospitals can also do a complex procedure less expensively by preventing complications and sending patients home faster.

"There really aren't any studies that demonstrate that as quality increases, costs can go down," Dr. Cameron said.

His pitch was clearly directed to the region's health maintenance organizations, which he said often direct patients to community hospitals because they are perceived as less costly. Overall, Hopkins and other large teaching hospitals charge more because they have to cover the cost of training doctors as well as treating patients.

Using figures kept by the Maryland Health Services Cost Review Commission, researchers analyzed 502 Whipple procedures done in Maryland between 1988 and mid-1993. Of these, more than half -- 271 operations -- were performed at Hopkins, with the rest spread among 38 other hospitals.

Among the findings:

* At Hopkins, 2.2 percent of patients died in the hospital, compared with an average of 13.6 percent of patients elsewhere. When individual hospitals were analyzed, those doing the fewest procedures had the highest death rates.

* Patients spent an average of 23 days in the hospital at Hopkins, compared with 27 days at the other hospitals. At Hopkins, patients also spent fewer days in the intensive care unit.

* The average patient was billed $26,204 at Hopkins, compared with $31,215 at the other hospitals.

The hospital decided to study the costs associated with the Whipple procedure a few years ago when cancer patients reported that their HMOs had denied their choice of Hopkins and steered them instead to a community hospital, Dr. Cameron said.

The study is due to be published in tomorrow's Annals of Surgery.

Dr. Gordon, vice president for planning and marketing, said the hospital has seen a 50 percent increase in its Whipple caseload over the past year -- in part because it has begun to share its cost data with the HMOs.

Long-term survival rates could not be compared because no one keeps definitive data on what happens to patients once they leave the hospital. In general, about a quarter of all patients undergoing the Whipple procedure at high-volume hospitals live at least five years, Dr. Cameron said.

Although not one of the most common cancers, pancreatic cancer is one of the most lethal. It is the fifth leading cause of cancer death, after malignancies of the lung, colon, breast and prostate.

In the Whipple procedure, surgeons attempt to stem a patient's cancer by removing part of the pancreas and an adjacent loop of the duodenum. It is reserved for patients whose cancer has not spread.

In studying other high-risk procedures, Hopkins hopes to make the case that insurance companies and, possibly, state regulators should designate certain hospitals as "centers for excellence" for certain complicated procedures.

Dr. Cameron conceded that community hospitals can probably do basic operations such as hernia repairs and gallbladder removals more cheaply and just as safely. If patients are directed to Hopkins for the riskiest operations, he said, they might have to be directed elsewhere for the less complicated ones.

Marsha G. Goldfarb, an economist at the University of Maryland Baltimore County who has researched the hospital industry, said she wasn't familiar with the Hopkins report but thought its findings were "plausible."

"If, in fact, their success rates are that superior to other hospitals, then it's perfectly reasonable that the reduced length of stay might also reduce costs," she said.

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