Practice, Practice

You've got a lot to think about when you're facing a high-risk operation, not the least being how to pick the right surgeon for the job. There's more to look at than a pleasant demeanor and an Ivy League med school. One of the most important--and most overlooked--considerations is how many times the doctor you have in mind has performed the operation you need. A new study suggests the answer may be literally a matter of life and death.

Surgeons who have performed a high number of certain difficult procedures have significantly better success rates than those who haven't, according to an article published in the New England Journal of Medicine. Dr. John Birkmeyer, general-surgery chief at Dartmouth-Hitchcock Medical Center in Lebanon, N.H., reviewed the charts of nearly 475,000 Medicare patients, all of whom had undergone one of eight high-risk operations, such as heart procedures or surgery for lung or pancreatic cancer.

Birkmeyer found that the patients were 1.2 to 2 times as likely to die if their heart operation was performed by a low-volume surgeon (someone who had done the procedure fewer than 40 times a year in the past two years). For cancer patients, the numbers were even more striking. Unless a surgeon had performed 162 operations a year over the past two years, the likelihood of death was 1.2 to 3.6 times as great.

Certainly, a high case count is not the only reason to pick a surgeon. A doctor who has performed a particular operation many times but did so years ago may not be as good a bet as one who has not logged as many but has done a lot of them recently. It's also important to check out the hospital. Larger, high-volume hospitals may have superior technology and better general resources.

While the study may drive patients to more seasoned M.D.s, making it harder for less seasoned ones to get needed practice, you still have the right to know your surgeon's case count. Websites and directories provide only academic back-ground and credentials, so the best approach is simply to ask. Remember, you're not only a patient, you're a consumer.

Sanjay Gupta is a neurosurgeon and CNN medical correspondent