Quality of minor surgery is better in secondary care
A study report in the latest Health Technology Assessment Journal has found that the quality of minor surgery carried out in general practice is not as high as that carried out in hospital, using surgical quality as the primary outcome.
The study was conducted in the south of England and the type of surgery was mainly dermatological procedures and ingrowing toenails. Quailty was measured primarily by wound appearance, and then by satisfaction with care and safety of surgery in terms of recognition of and appropriate treatment of skin malignancies.
Wound appearance was significantly better in the hospital group as was the ability of the doctors to achieve complete excision of malignancies. However, patients tended to be more satisfied with having the procedure in primary care, most likely due to convenience.
The mean cost of hospital-based minor surgery was £1222,24, considerably higher than the £449.74 for primary care. However, the authors point out that if you take postoperative complications as an outcome (where both groups had similar results), both effectiveness and costs of alternative interventions are uncertain. If, however, you take completeness of excision of malignancy as an outcome, hospital minor surgery becomes more cost-effective.
The study concluded that as safety of patients is of paramount importance, this study demonstrates that minor surgery carried out in primary care is not safe, especially in terms of the ability of GPs to recognise malignant lesions and completeness of excision compared with hospital doctors.