Patients Should Know About the Surgery Quality Blind Spot

COMMENTARY

Each year, millions of Americans face a decision that’s more consequential than buying a home or car: choosing where to have major surgery. For procedures like spinal fusions and hip and knee replacements — among the most common operations in medicine — the choice of hospital can mean the difference between a full recovery and months of avoidable setbacks, pain and stress.

Yet while a car purchase comes with detailed safety ratings and prospective homebuyers can obtain inspection reports, patients preparing for surgery are left largely in the dark — even though surgical complications can lead to extended hospital stays, additional procedures and sometimes permanent disability.

The data is telling.

An analysis of over 2.3 million Medicare surgeries — including more than 1.8 million musculoskeletal procedures like hip and knee replacements — revealed a troubling pattern of inconsistent care. Surgical outcomes varied dramatically between hospitals, with readmission rates at different facilities ranging from less than 5% to over 10%. It found substantial variations in quality even among hospitals in the same network.

Luckily, there is one telltale indicator of the risk associated with having surgery at a specific hospital — volume, or how many procedures a hospital performs annually. Studies show that high-volume hospitals consistently achieve better outcomes across multiple types of surgery.

This makes the current approach to choosing surgical care deeply concerning. Research shows that most patients select hospitals based on data-free factors like word-of-mouth recommendations or doctor referrals. These recommendations and referrals aren’t always completely objective, especially as health systems increasingly pressure physicians to refer patients within their own systems.

Patients can become their own best advocates — by examining the data in five critical areas.

First, look at success rates — how well patients actually recover. The best hospitals track and share their patients’ improvements in quality of life, pain levels and function after surgery.

Second, examine patient experience scores. They contain a wealth of information about how well a hospital communicates, coordinates care and supports patients through their journey.

Third, dig into complication rates. Find out how often things go wrong and how well the hospital handles the challenges that arise.

Fourth, examine readmission rates, which are particularly telling. How often do patients end up back in the hospital unexpectedly? Low rates of readmission signal that a hospital excels at preventing complications and managing the overall process of recovery.

Fifth, consider procedure volume — the number of specified surgeries the hospital performs. Experience matters, and high-volume centers tend to deliver better results.

Together, these five measures paint a clear picture of hospital quality and should be readily available to any patient considering surgery. Yet all too often this information is difficult or impossible to find. 

Currently, there are few resources available to patients interested in comparison shopping. While the Centers for Medicare and Medicaid Services provides some hospital comparison tools, they’re clunky and incomplete. Private insurers have detailed data on their providers’ outcomes, but many choose not to share it.

Easier access to comparisons would be game changing, both for patients and the health care system as a whole. Just as vehicle safety ratings spurred car makers to compete on crash protection, surgical outcome transparency could drive providers to improve their results. 

Research suggests that simply publishing complication rates motivates hospitals to enhance their safety practices.

Accountability would also drive significant financial savings. One estimate shows that hospital readmissions within the first 30 days alone cost our health care system well over $50 billion.

Every preventable complication consumes health care resources that could be better spent expanding access to care. 

Some leading health systems are already moving toward greater transparency by publishing online data on their outcomes. These pioneers recognize that informed patients make better decisions and have more realistic expectations about recovery.

Patients scheduling surgery shouldn’t settle for less information than they’d want when buying a car — and our health care system shouldn’t make finding it any harder than reading a window sticker.

Mathias P. Bostrom, MD, is associate surgeon-in-chief and director of quality and safety at the Hospital for Special Surgery. HSS can be found on LinkedIn.