As a neurosurgeon with subspecialty training and experience in cerebrovascular surgery, I am concerned about highlighting the performance of certain complex surgeries at community hospitals ("Highmark Working Out How to Keep Care at Local Hospitals," May 23 Business). Although the idea of having one's medical care provided closer to home is laudable, and most general conditions often can and should be treated at community hospitals, numerous recent studies across a variety of medical specialties strongly indicate that technically challenging problems (such as surgical treatment of brain aneurysms) are best managed in tertiary referral facilities where experienced specialists are available around the clock, prepared to handle any potential challenges that may arise.
Research shows that patients with cerebral aneurysms have a statistically higher chance for survival and a lower risk of complications if they are treated in a facility that regularly sees a greater number of such patients. Most neurosurgeons who have extensive experience in performing complex aneurysm procedures understand that it is a risky proposition to do this as a "lone ranger" in a setting where, unlike UPMC Presbyterian or West Penn Allegheny General, there are few or no experienced support staff, including backup neurosurgeons and experts in critical care of the brain, in house all the time, ready to assist if and when things do not go according to plan.
Contrary to the sentiment conveyed in the article, the practice of a single doctor combating a challenging disease in a relatively remote outpost because it is convenient for the patient does not represent modern or advanced neurosurgical care. In fact, it represents a return to the past, a "wild west" of great risk and uncertain outcomes. We -- the neurosurgical community -- are certainly capable of much better.
DANIEL A. WECHT, M.D.
Department of Neurosurgery