Best Hospitals 2007
When You Need the Best
Indeed, many people who need treatment but are at high risk for a poor outcome are apt to be turned away by their local healthcare system. Meantime, the country's best hospitals are constantly devising ways to overcome medical handicaps such as old age and obesity, the latter a real and growing concern.
Not long ago, for example, advanced years were an automatic disqualifier for big operations, and many surgeons still are uncomfortable working on people above a certain age. But physicians have developed ways to cope with fragile tissue and bone, and elderly patients have shown themselves to be quite resilient after the insults of surgery. At large referral centers, even nonagenarians now roll into operating rooms at a steady pace.
Obesity needn't preclude treatment, either, but it's a reason to look for expertise. Penetrating thick layers of fat and keeping far more blood vessels than usual from turning into bleeders add to the time spent under anesthesia, itself a risk. And a drumbeat of studies demonstrates that obesity worsens the outcomes of many procedures. Findings released in May, for example, show that abnormal heart rhythms were 61 percent more likely after radio-frequency ablation, a corrective treatment, in patients with a body mass index above 30 (indicating obesity) than in those whose BMI was normal. Next month, the journal Cancer will report that obese patients with prostate cancer who are treated with radiation are two-thirds more likely to have a recurrence than those who aren't obese.
One important job of the experts is to figure out which vulnerable patients can't be helped. A long list of potentially dangerous complications--infection, collapsed lung--faces candidates for the lung volume reduction operation, for example. A team of specialists is needed, just as it is with transplant surgery, to screen out the highest risks, identify the patients most likely to benefit, and work with them after they recuperate to keep up their gains. At Ohio State, which recently became the first hospital to meet specific new standards for lung volume reduction programs set by the Joint Commission on Accreditation of Healthcare Organizations, 75 percent to 80 percent of those who come seeking care are rejected.
Sandra Lecraft of Coshocton, Ohio, made it through the screening. Housebound and barely able to walk 100 feet, she had been using oxygen tanks 24 hours a day. The payoff was immediate. "I woke up in the ICU and said, 'I don't feel like there's somebody sitting on my chest,'" says Lecraft, 63. Out went the oxygen tanks. Lecraft now walks 3 to 4 miles four times a week, rides an exercise bike twice weekly, and occasionally swims.
ICU TIME IS A POSSIBILITY
A serious case of pneumonia or heart failure, say, or a complex surgical procedure such as the removal of part of a cancerous organ is most likely to mean a day or more in an intensive care unit. If there's time to make a choice of hospitals beforehand, a large center could be your best shot at being cared for in an ICU run by trained, certified intensivists.
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