Surgeons' Complication Rates Available to Patients

ProPublica develops a database of what it calls surgeons’ adjusted complication rates based on Medicare records of common elective surgeries

You go in to surgery expecting a quick recovery with no complications, but a new online database shows you how often surgeons’ patients get readmitted to the hospital for complications like post-operative pain, infections, and blood clots.

The non-profit news group ProPublica used five years of Medicare records for eight lower risk elective surgical procedures, including knee replacements, hip replacements and gallbladder removals, to create its “surgeon scorecard”, a database that includes what it describes as the adjusted complication rates for thousands of U.S. surgeons.

“These are surgeries where patients would have a reasonable expectation of not suffering some type of harm and we're identifying the cases where they did have some type of harm,” said ProPublica reporter Marshall Allen.

The data may reveal how surgeons may differ from their peers even at the same hospital.

“We found surgeons with high complication rates in some of the most respected prestigious hospitals in the country in terms of reputation,” said ProPublica reporter Marshall Allen.

Tony Ingram of Homer Glen said the database would have been useful before his knee replacement surgery in late 2013. Ingram suffered a post-operative infection following his surgery and said he still deals with pain in his knee.

“I would really, really suggest that people reach out and research it a little bit: the doctor, the hospital and the product that they’re going to use,” Ingram said.

Even though a surgeon may not be to blame for a complication, the American College of Surgeons says a surgeon is considered responsible for a patient’s care from the pre-operative exam through the rehabilitation.

The analysis shows the average complication rate was between 2 and 4 percent, although some doctors had complications in more than 1 in 10 surgeries.

For example, the average adjusted complication rate for knee replacement surgery is 2.3 percent. According to Medicare data between 2009 and 2013, a Chicago surgeon had a 5.7 percent adjusted complication rate based on 24 complications in 219 knee replacement procedures. ProPublica said the Chicago surgeon’s rate is among the highest in the country for the procedure.

The surgeon told NBC 5 Investigates his practice involves the referral of complicated orthopedic patients. The surgeon said first time total knee replacement accounts for only 10 to 20 percent of his practice and more than half of those patients have high risk orthopedic problems. The surgeon also said the ProPublica study does not risk adjust for this type of patient and problem.

According to ProPublica, its statistical analysis accounts for issues such as the age and health of patients. And the group consulted with surgeons to identify whether certain complications related to surgeries.

The American Academy of Orthopaedic Surgeons said even though the ProPublica study can be useful, the data used in the study is limited.

“What this study shows is simply complications. It does not show what the outcomes are,” said former AAOS president Dr. Joshua Jacobs.

Jacobs said the study does not factor in patients’ social situations, which can lead to readmissions.

“It’s difficult to make conclusions, for example, if you’re just a patient going on the website,” Jacobs said. “I think you need to have a little more information than just this data to choose a surgeon.”

The Illinois Hospital Association said while the database can be another tool to improve care for patients, hospitals already monitor surgeon complications in different ways. The IHA points to the Hospital Engagement Network, an agreement between the Centers for Medicare & Medicaid Services’ Partnership for Patients campaign and the American Hospital Association, which aims to substantially reduce patient harm and readmissions.

Still, Chicago orthopedic surgeon William Robb, who served as a consultant on the study, said the database will drive improvement.

“There’ll be questions about how it was done and what that data actually means. But out of it, I believe, there will be improvements, even though individual surgeons, perhaps, or individual hospitals, perhaps, may push back a little bit,” Robb said.

Hospital readmissions cost taxpayers $645 million between 2009 and 2013.

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