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Cirugía como mínimo invasora extensamente underused

por Lauren Dubinsky, Senior Reporter | July 14, 2014
Dr. Marty Makary
Courtesy of Johns Hopkins Medicine
Even though minimally invasive surgery leads to fewer complications compared to traditional, open surgery, it's underused in many U.S. hospitals, according to a recent study published in the British Medical Journal.

"One of the great academic problems in American health care is variation in the way people like to do things in medicine," Dr. Marty Makary, senior author of the study and professor of surgery at Johns Hopkins University School of Medicine, told DOTmed News.

Makary and his fellow researchers gathered information from the Nationwide Inpatient Sample, which contains data detailing over seven million hospital stays including the patients' characteristics and their conditions and treatments. The researchers then analyzed the data to determine how many minimally invasive procedures the hospitals could perform based on the standard qualifications for four procedures: appendectomy, colectomy, hysterectomy and lobectomy.

The researchers found that there were significant variations between the 1,051 hospitals in the number of minimally invasive surgeries they conducted. For example, for appendectomy surgery, 71 percent of the surgeries could be performed as minimally invasive procedures, yet only one-quarter of the hospitals preferred that option for most of the cases.

The researchers believe that it's an issue since the complication rate for minimally invasive surgery is considerably lower than the rate for open surgery for many operations. Dr. Michol Cooper, another researcher who was involved in the study, and her colleagues used the database to compare complication rates between minimally invasive and open surgery for the four procedures.

She uncovered that minimally invasive appendectomy surgery has about one-half the complications that the open appendectomy surgery has. Additionally, minimally invasive colectomy surgery has about one-third of the complications of the open surgeries.

Makary said that the reason for the disparity is the differences in physician training in hospitals across the country. "Like other problems in medicine, the variation is a tremendous problem and it's a management and training problem not a bricks and mortar or technology problem," he said.

Physicians tend to stick with the technique that they were trained in. "You train in an area and you learn a bunch of operations and you tend to focus on a couple or a dozen of those operations that you end up doing repeatedly for the rest of your career," Makary said.

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