France urged to close high risk operating theatres

A report commissioned by the French health ministry has recommended the immediate closure of operating theatres in 113 small public hospitals around the country.

Patients having surgery in these small hospitals are at risk, the report said, because they have poor facilities and their surgical teams lack appropriate experience as they do not operate often enough.

The findings of the report, written by Dr Guy Vallancien, secretary general of the National Surgical Council, a health ministry advisory group, were made public last week by the daily newspaper Le Monde.

“Certain local hospitals have surgical services that do not meet the criteria of safety, quality, and continuity of treatment,” the report said. “They must be closed down without delay.” The report added that whereas people would find it unacceptable for an airport to remain open in unsafe conditions, this does not seem to have been the case with hospitals performing risky surgery.

It says that operating conditions in some of the hospitals are in a “more than precarious” state either because the theatres or recovery rooms are below standard or because the experience of the surgeons is lacking. It also refers to the possible problems arising from many of the surgeons in these hospitals having trained outside Europe.

The report uses two examples to show that such hospitals are less effective than in hospitals with higher rates of operations. Citing radical prostatectomy for cancer, it said that for 72 700 such operations between 2000 and 2004, overall mortality was 0.10 %. For theatres that do more than 100 operations annually, the rate is 0.04 %. However, for the theatres mentioned in the report (which do less than 50 prostatectomies annually), mortality was 0.14 %. Mortality after removal of the colon for colon cancer was also increased in those theatres that did fewer operations.

The report recommends integrating the operating facilities in smaller hospitals with those in larger regional hospitals. The smaller hospitals' facilities would then be used to create more beds for elderly people or for postoperative treatment. The 126 655 operations that took place in the smaller institutions would translate to about 330 more operations a year in each of the larger institutions, or about 2% to 12% more.

The report says that France leads the world in its ratio of public and private medical hospitals or clinics to population—1 for every 20 000 inhabitants, compared with 1 for every 100 000 in Sweden and 1 for every 40 000 inhabitants on average in Europe.

The report recommends that by 2007 the health ministry publish recommendations on the number of operations that should be carried out annually and it recommends a classification system of all institutions that carry out surgery, based on safety, quality, and continuity of treatment.