Volume standards for high-risk surgical procedures: Potential benefits of the Leapfrog initiative

Background. As part of a broader effort aimed at improving hospital safety, a large coalition of employers, the Leapfrog Group, will soon require hosp itals caring for their employees to meet volume standards for 5 high-risk s urgical procedures. T-W estimated the potential benefits of full nationwide implementation of these volume standards. Methods. Using data from Nationwide Inpatient Sample and other sources, we first estimated the total number of each of the 5 procedures-coronary-arter y bypass graft, abdominal aortic aneurysm repair, coronary angioplasty, eso phagectomy, and carotid endarterectomy-performed each year in hospitals in US metropolitan areas. (Leapfrog exempts hospitals in rural areas to avoid access issues.) We then projected the effectiveness of volume standards (in terms of relative risks of mortality) for each procedure using data from a published structured literature review. Results. With full implementation nationwide, the Leapfrog volume standards would save 2581 lives. Of the procedures, volume standards would save the most lives with coronary-artery bypass graft (1486), followed by abdominal aortic-aneyrysm repair (464), coronary, angioplasty (345), esophagectomy (1 68), and carotid endarterectomy (118). In our estimates of the number of li ves saved, we considered assumptions about how many patients would be affec ted and the effectiveness of volume standards (ie, strength of underlying v olume-outcome relationships with each procedure). Conclusions. If the Leapfrog volume standards are successfully implemented, employers and health-care purchasers could prevent many surgical deaths by requiring hospital volume standards for high-risk procedures.