Online Scorecard Shows Surgeons' Complication Rates

July 15, 2015

Patients have another searchable online tool for choosing a physician, this one reporting complication rates for eight elective surgical procedures by individual physician.

ProPublica, an investigative news organization that has analyzed other aspects of medical practice, posted its Surgeon Scorecard with complication rates for almost 17,000 surgeons on July 13. The data are based on Medicare billing records. An accompanying news article reported that overall complication rates, based on hospital readmissions within 30 days of the surgery and death during the initial stay, ranged from 2% to 4% during the 5-year study period. Remarkably, almost 800 surgeons who performed at least 50 procedures had no complications to their name, proof that their colleagues have room for improvement, ProPublica said.

The eight procedures in question are knee replacement, hip replacement, gallbladder removal, prostate removal, prostate resection, and three types of spinal fusion — one involving the neck, and two involving the lower back. ProPublica said it selected these eight procedures because they are typically performed on healthy patients and "are considered relatively low risk." The database excludes trauma and other high-risk cases more prone to complications as well as procedures performed on patients admitted from a hospital emergency department or some other healthcare facility.

Not every 30-day readmission counts as a reportable complication. In consultation with surgeons and other physicians, ProPublica confined itself to readmissions that could be "reasonably attributed to complications from surgery," and not some other aspect of care. Such complications include infections, blood clots, uncontrolled bleeding, and misaligned orthopedic devices. At the same time, the news organization said that surgeons "should be accountable for everything that happens to their patients," noting that the American College of Surgeons (ACS) holds the same view. (An ACS spokesperson said the group was not yet ready to comment on the scorecard.)

In all, the Surgeon Scorecard database reports complication rates on the basis of death and 30-day readmissions for 16,827 surgeons at 3575 hospitals during the study period of 2009 through 2013. ProPublica adjusted the rates to reflect factors such as the age and health of each patient, the overall performance of the surgeon's hospital, and even good and bad surgical luck. The database does not include complication rates for physicians who performed an operation fewer than 20 times.

ProPublica said it identified 63,173 patients who were readmitted with a complication, and 3405 deaths.

What Patients Really Want to Know

Some initial reviews of Surgeon Scorecard point out the challenges posed by a limited data set.

David Teuscher, MD, president of the American Academy of Orthopaedic Surgeons (AAOS), told Medscape Medical News that ProPublica's methodology "looks to be appropriate and fair." However, Dr Teuscher said he wonders if the adjustments to complication rates are granular enough to account for all patient differences.

Physical deformity and prior surgery also factor into complications, he said. "We haven't stratified all orthopedic risks." In addition, Medicare claims data provide a limited picture of a patient's clinical status.

The inability to fully account for patient differences, he said, could motivate surgeons to turn down complication-prone cases lest they result in poorer numbers on Surgeon Scorecard.

 
More information is better than less. Dr David Teuscher, AAOS president
 

Nevertheless, "probably more information is better than less," Dr Teuscher said. "We're certainly interested in transparency. We think informed patients make better patients."

Donald Goldmann, MD, chief medical and scientific officer at the Institute for Healthcare Improvement in Cambridge, Massachusetts, also believes in the notion of enlightened patients. Surgeon Scorecard, however, doesn't go far enough in helping them choose a surgeon, he told Medscape Medical News.

"This is just about readmissions and deaths," said Dr Goldmann, who is also a clinical professor of pediatrics at Harvard Medical School. "That's interesting, but that's not going to drive my decision.

"If I'm having a prostate procedure, I want to know my risk of winding up impotent, or incontinent. If I have a knee replacement, I want to know what my functional status is likely to be a year from now. That's what matters to the patient."

In a question-and-answer section on its website, ProPublica seems to anticipate the misgivings of Dr Teuscher and Dr Goldmann.

"We believe that patients, hospital administrators and doctors are better off having information with limits than having no information at all," it said. ProPublica noted elsewhere that it welcomes physician suggestions on how to improve the usefulness of its scorecard.

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