Better data collection required, some consolidation of services may be
SASKATOON, Sept. 13 /CNW/ - Saskatchewan patients are receiving surgical
care that is generally comparable in quality to that provided elsewhere in
Canada, says a report released today by the province's Health Quality Council.
The study, which looked at eight complex surgeries performed only in
Saskatoon and Regina hospitals, found most hospitals and surgeons are doing
sufficient numbers of these procedures to ensure safe, high-quality care. HQC
also found that, in most cases, patient outcomes (as measured by mortality, or
death, rates) are in line with benchmark figures from elsewhere in Canada and
abroad. The medical literature shows that, for some surgeries-including the
eight HQC studied-patients operated on in hospitals or by surgeons that do
more of that procedure have better outcomes.
The Health Quality Council looked at volumes and patient outcomes for the
following procedures (definitions attached): coronary artery bypass graft
(CABG); percutaneous coronary intervention (PCI); ruptured and unruptured
abdominal aortic aneurysm repair; carotid endarterectomy; and cancer
resections (esophageal, pancreatic, and hepatic cancer resections). Although
the Council identified some instances where individual hospitals or surgeons
are not doing as many procedures as research evidence suggests they should be,
patient outcomes in these cases were no worse than those for higher volume
hospitals or surgeons.
Because Saskatchewan has a small population, it was not surprising to
find certain hospitals or surgeons had lower volumes, says Melanie Rathgeber,
a program director at HQC and lead researcher on this project. "While we
didn't see worse outcomes in these cases, other jurisdictions have set minimum
thresholds based on evidence of the link between higher volume and better
outcomes. We hope health care planners and providers will look to this report
when making decisions about the best ways to organize and deliver surgical
care and monitor patient outcomes in Saskatchewan."
Other key findings:
- There are very small numbers of cancer resections being done in this
province and they are spread across most of the hospitals in
Saskatoon and Regina.
- The number of coronary artery bypass graft (CABG) procedures being
done at Royal University Hospital (RUH) does not meet the volume
threshold used in other Canadian jurisdictions.
- Very small numbers of carotid endarterectomies are being done at RUH.
Royal University does fewer of these procedures than other
Saskatchewan hospitals (where it is performed) and fewer than the
- Saskatchewan has a higher mortality rate for PCI, despite the fact
that hospitals and surgeons meet minimum volume thresholds. This
finding needs to be investigated further to understand the reasons
or the higher rate.
- Although most surgeons met the minimum volume threshold for CABG,
there were some years in both Saskatoon and Regina where a surgeon or
surgeons did not meet this mark.
Current data collection systems did not allow HQC to make an
apples-to-apples comparison of outcomes for individual hospitals or surgeons
(e.g., some patients may be sicker and/or at higher risk of a poor outcome
"Collecting better quality data, on a regular basis, will make it easier
to monitor and report on patient outcomes," says Rathgeber. "Our findings
raise a number of additional questions, most of which cannot be answered by
the data currently available. Ongoing comparison of outcomes, both within our
own province and with providers/facilities in other jurisdictions, will help
ensure Saskatchewan residents are receiving high-quality surgical care."
The report, Quality of surgical care in Saskatchewan: A look at eight
complex procedures, is available on the Health Quality Council web site:
HQC is an independent agency with a mandate to measure and report on
health system performance and work with providers and managers to improve
quality of care.
Definitions of procedures
Coronary artery bypass graft (CABG): Surgery that reroutes blood flow
around blocked arteries of the heart, to restore blood supply to the
Percutaneous coronary intervention (PCI): Non-surgical procedures
(balloon angioplasty and stents) to open blocked arteries and restore
blood flow to the heart.
Ruptured and unruptured abdominal aortic aneurysm repair: Surgical repair
of a bulge or widening of the aorta, which is the main artery coming from
the heart and extending into the abdomen.
Carotid endarterectomy: Surgical removal of plaque deposits that are
restricting blood flow in the carotid artery in the neck, which moves
oxygen-rich blood from the heart to the head and brain.
Esophageal, pancreatic, and hepatic cancer resections: Surgical removal
of a portion of the organ or body part (esophagus, pancreas, or liver)
affected by cancer.
For further information:
For further information: Sheila Ragush, Communications Consultant,
Phone: (306) 220-5075 (mobile) or (306) 668-8810 ext 113 (land)