There are widespread and avoidable complications for common, elective surgeries, according to industry experts — and data seems to back this up. But how can you gauge the proficiency of the surgeon performing a procedure on you?
A new database from the investigative news site ProPublica tries to answer this question. The tool, Surgeon Scorecard, uses Medicare data to find the complication rates of eight elective procedures performed by nearly 17,000 surgeons at 3,600 hospitals. (These are surgeries that ProPublica found are “typically performed on healthy patients and are considered relatively low risk.”)
The analysis shows that just 11 percent of those surgeons account for a quarter of the complications. In five years, a total of 63,174 patients were readmitted for avoidable complications — and 3,405 of them died.
But the database also lets you dig into the performance of individual surgeons. It tallies readmissions and deaths for each surgeon, then divides that by the total number of times the surgeon performed a given procedure, then ranks them as having a low, medium or high complication rate.
“As a tool, its value is that it informs patients. The surgeons are responsible for the complications,” said Lisa Freeman, executive director of the Connecticut Center for Patient Safety. “It’s alerting you to the fact that there are complications, and there doesn’t have to be.”
But this feature has critics who say it relies on limited sample size and overgeneralizes about patient health.
Because this tool uses limited Medicare data, in some cases the dataset only includes information on 20 instances in which a surgeon performed a given procedure. So ProPublica used what is called a “confidence interval” to calculate the possible range of values, with about a 95 percent confidence level. But as DataSurg reported, these intervals were so wide that the complication rates had to be taken with a huge grain of salt. DataSurg is a data blog run by a surgeon.
“Due to the small number of procedures, all we can conclude is that this surgeon has either a low, medium, or high adjusted complication rate. Not very useful,” wrote Ewen Harrison, author of the DataSurg article.
ProPublica also acknowledged that grading surgeons based on complications might motivate them to perform surgery only on healthier patients, possibly leading to the turning away of some sicker patients.
But Freeman says there is value in ProPublica’s methodology, and contends that making the data available empowers and protects patients by allowing them to make the most informed decisions about their health.
“Unfortunately, patients aren’t aware that there is a lot of information out there that can inform them. It’s the obligation of medical care providers to inform, but up until recently, there was little in any arena that supported transparency in data,” Freeman said.
Beyond this database, Connecticut patients have more resources to get a fuller picture of a surgeon’s past performance. For example, a patient could search the Connecticut Judicial Branch website for any current civil litigation against a surgeon, or they could check with the state Department of Public Health to see if they have been disciplined.
Reviewing a surgeon’s data to ask informed questions shifts the power to the patient, Freeman said.
“People in my parents’ generation would do whatever the doctor told them because it was assumed the doctor had their best interest at heart. Today, there is more carryover from the patient and provider perspective,” Freeman said. “Providers need to open the doors for questions and transparency.”