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Letters to the Editor to:

Scientific Articles:
G. William Woods, Daniel P. O'Connor, and Peggy Pierce
Orthopaedic Surgeons Do Not Increase Surgical Volume After Investing in a Specialty Hospital
J Bone Joint Surg Am 2005; 87: 1185-1190 [Abstract] [Full text] [PDF]
*Letters to the Editor: Submit a response to this article

Electronic letters published:

[Read Letter to the Editor] Dr. O'Connor et al respond to Drs. Sambandam and Gul
Daniel P. O'Connor, G. Willam Woods, Peggy Pierce   (28 June 2005)
[Read Letter to the Editor] Other Factors Influencing Surgical Volume
Senthil Nathan Sambandam, Arif Gul   (20 June 2005)

Dr. O'Connor et al respond to Drs. Sambandam and Gul 28 June 2005
Previous Letter to the Editor Top
Daniel P. O'Connor,
Director
Joe W. King Orthopedic Institute, Houston, Tx 77030,
G. Willam Woods, Peggy Pierce

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Re: Dr. O'Connor et al respond to Drs. Sambandam and Gul

dano{at}jwkoi.com Daniel P. O'Connor, et al.

We thank Drs. Sambandam and Gul for their comments. Their letter states that they “believe that financial investment in a specialty hospital may well change a surgeon’s practice patterns”, but they “do not have any evidence to support this belief.”

Regrettably, arguments based on beliefs rather than evidence dominate the discussion of surgeon investment in specialty hospitals. We presented evidence, not our beliefs. We respond by presenting more evidence.

In the first year of the study period, the ten orthopaedic surgeons were 32, 34, 36, 37, 37, 38, 40, 41, 44, and 47 years of age. There was no relation between surgeon age and either change in surgical volume (r = 0.13) or change in surgical rate (r = –0.03).

To our knowledge, detailed 15-year trends for individual orthopaedic surgeons or group practices are not readily available. Our stated purpose was to determine whether one group changed its practice over time. Comparisons to other groups are not directly relevant to our purpose and would not affect our conclusions.

Changes in surgical rates by orthopaedic subspecialization were: knee/sports medicine, –4.0%; foot and ankle, –3.0%; hand and upper extremity, +0.7%; spine, +3.0%; pediatric, +7.0%; and joint replacement, +10%. These relative changes were small in absolute terms, averaging a difference of 1 or 2 cases per surgeon per month.

We appreciate the opportunity to present this additional evidence. We hope that evidence prevails over belief in the ongoing discussion of this issue.

Sincerely,

G. William Woods, MD,

Daniel P. O’Connor, PhD,

Peggy Pierce, BBA
Other Factors Influencing Surgical Volume 20 June 2005
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Senthil Nathan Sambandam,
Junior medical officer in Orthopaedics
University Hospital Of North Staffordshire , Stoke on Trent, Uk ST46TB,
Arif Gul

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Re: Other Factors Influencing Surgical Volume

sam_senthil2002{at}yahoo.co.in Senthil Nathan Sambandam, et al.

To the Editor:

In contrast to the conclusions of this article, we believe that a financial investment in a specialty hospital may well change a surgeon's practice patterns. Even though we do not have any evidence to support this belief we disagree with the statistical evidence given by the author to justify conclusions like "the average number of surgical procedures per year performed by investing surgeons was not affected by the opening of the specialty hospital and the patient volume and the percentage of patients receiving surgery were not affected by the opening of the specialty hospital."

This is a retrospective study in which the author has collected the number of procedures performed by 10 surgeons in a 15 year period (7 years before and 8 years after the start of financial interest in speciality hospital). This study considered only the number of operations and the rate of increase in the surgical practice as outcome variables. But these variables depend on many other factors. Over a period of 15 years, orthopedic practice patterns have a natural tendency to change. This study made no mention about the ages of the surgeons. Hence this study compares the number of operations performed by the surgeons when they were comparatively young and enthusiastic without financial interest in a speciality hospital to the number of operations performed by the same surgeon when he is older and presumably less surgically active, albeit with a financial interest. Hence, we think it is difficult to conclude that there is no change in the practice unless we know the normal trend, over a period of 15 years, of the number of surgeries performed and rate of change in the number of surgeries performed by surgeons who continued their practice in a full service hospital without financial interest in speciality hospitals.

Furthermore, this study made no mention of the influence on operative rates of different sub-speciality interests. In some subspecialties, the rates of surgery have increased, while in others, there is a trend toward non operative management.

Yours sincerely,

Mr. Senthil Nathan Sambandam, MS, MRCS

Mr. Arif Gul, MS, MRCS