The Specialized Field of Fetal Surgery
October 9, 2018 3:24 PM   Subscribe

This really hit home for me. My coworker's first child(ren) were MoDi and they decided to only keep one to improve survival chances. But what a set of decisions to make on your very first pregnancy. :/
posted by crankytalking at 4:30 PM on October 9, 2018

Oh. That last sentence literally brought tears to my eyes. I didn't know I needed to read something about someone who is truly doing good work- amidst all the news of those doing quite the opposite- thank you for posting.
posted by perplexion at 4:38 PM on October 9, 2018

The comment about the staff at some fetal health surgery programs being “undertrained” is not limited to that speciality. University hospitals have jumped into offering these flagship programs such as cardiac surgery, various transplantation programs, and very specialized centers such as those offering fetal/in utero surgery. For profit hospitals, like HCA in the article, also have opened such specialized centers as well, driven by PR and competition. They want to be able to sell themselves as “world-class” even if they do not have the staff or patient volume to support these programs. (The fact that these relatively rare diagnoses and hospitalizations fall outside of the DRG-based payment schemes and can allow truly eye watering charges plays no role, nossir.)

So you end up with programs doing so few procedures that success and complication rates go up, but they persevere. Recently Oregon Health Sciences U (the state medical school and tertiary referral center in Portland) closed their heart transplant program because of lack of trained transplant surgeons and cardiologists. There volume was low anyway. In Florida, we have 6 hospitals doing liver transplants, where it should probably be 2-3. Three of the centers do less than 70 a year, while the 2 largest do 200-250. In St. Lucie and Martin Cos, there are 2 competing hospitals doing less than 100 coronary bypass surgeries a year. Unfortunately, there is no regulatory body which can fix this.

If I ever need CABG, I’m flying back to Houston and getting on the assembly line at Texas Heart where they do >15 a day. A program like that has seen it all, more than once, and has the staff and experience an vanity program can never match.
posted by sudogeek at 7:10 PM on October 9, 2018 [9 favorites]

Fetal surgery is pretty amazing. The potential benefits for patients with spina bifida are enormous. Absolutely agree with sudogeek that it's best to go to high volume places esp for delicate/challenging procedures.
posted by n. moon at 5:55 AM on October 10, 2018

Well this was interesting, thank you. Our twins had twin to twin transfusion but didn't have fetal surgery because it was diagnosed too late in gestation (26 weeks), so they just delivered instead. I know several local families who were diagnosed earlier and traveled to Cincinnati for ablation surgery, and I was curious at the time as to how a given hospital ends up being a center for that.
posted by gerstle at 9:58 PM on October 13, 2018

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