The number of Americans getting bypass surgery plummeted 38 percent since 2001 as heart disease rates fell and doctors relied on less-invasive procedures to treat clogged arteries, researchers said.
Surgeons performed 1,081 bypass surgeries for every 1 million Americans in 2008, down from 1,742 per million in 2001, according to an analysis of data from hospitals and the U.S. Medicare health insurance program for the elderly. Angioplasty rates were 3,667 per million in 2008, a decrease from 3,827 per million in 2001, the study found.
The findings raise concerns that patients may not be getting the best treatment, said researcher Peter Groeneveld, an assistant professor at the University of Pennsylvania’s School of Medicine in Philadelphia. Recent studies show open-heart surgery is better than artery-clearing procedures that use metal stents to hold the treated vessels open, particularly for patients with severe disease, he said.
“I think there is a strong possibility that patients who need bypass surgery aren’t getting it,” said Groeneveld, from Penn’s internal medicine program, in a telephone interview. “These procedures aren’t exact substitutes. Bypass surgery is the right treatment for patients with severe disease.”
More than 1 million Americans undergo treatment to restore blood flow through their coronary arteries each year, costing Medicare more than $6.7 billion annually, the researchers said. While open-heart surgery often yields a more lasting result than artery-clearing angioplasty procedures, the operation is more arduous and the recovery period is longer, studies show.
130,000 Fewer Operations
The study, published in the Journal of the American Medical Association, was funded by the U.S. National Heart, Lung and Blood Institute, the Agency for Healthcare Research and Quality and the Pennsylvania Department of Health.
The results suggest there were 130,000 fewer bypass operations in 2008 than in 2001, while the total number of both kinds of procedures declined by 80,000 from 1.21 million, the researchers concluded.
Although operation rates fell, more hospitals performed the surgeries, the study found. The average number of operations each medical center handled by 2008 declined as a result, with one in four performing fewer than 100 surgeries each year. The resulting lack of experience among doctors and hospitals is also a concern for patients, Groeneveld said.
“Patients have to be very vigilant,” Groeneveld said. “They are likely to have options that include low-volume hospitals. Someone is getting surgery at these hospitals, and the worry is they are not getting good results.”
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