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Dr. Michaels' Blog

Should I Go To Mass General For The Operation?

I practice plastic surgery in Berkshire County, MA, and frequently witness patients leaving our area to go to Boston for surgery that could easily be done in Berkshire County. I also frequently see the same patients back from Boston either for follow up or to care for a surgical complication. I do counsel patients to go to Boston for care if it is too complex a problem or procedure. But what about simple commonly performed procedures? Should you stay or should you go? This question was recently addressed in an Article in The Journal of American Medical Association.1

The authors reviewed over 1.6 million Medicare admissions to both 828 small and 3676 large hospitals for 4 common surgical procedures; appendectomy, gallbladder removal, colon resection, and hernia repair. Because the larger hospitals often cared for sicker patients with many medical problems the authors compared risk-adjusted outcomes between the two types of hospitals. They specifically compared deaths, serious complications, and cost.

The authors found that although small and large hospitals had the same rates of death, the small hospitals had fewer serious complications and were 8.8% less expensive, saving an average of $1395. They concluded that for commonly performed procedures like colon removal for cancer, or hernia repair, small hospitals were both safer and less expensive than large hospitals.

So for my patients inquiring about cosmetic surgery, skin cancer surgery or breast cancer reconstruction, I can explain with confidence that you’re better off in the Berkshires.


Association of Hospital Critical Access Status With Surgical Outcomes and Expenditures Among Medicare Beneficiaries, Ibrahim AM, Hughes TG, Thumma JR, Dimick JB, JAMA. 2016;315(19):2095-2103