Surgical complications depend more on the surgeon than the hospital where the procedure was performed.
In 2012, 71-year-old LaVerne Stiles had spinal fusion surgery to repair a small fracture caused by a car accident a few weeks before. When she chose between the three surgeons at her nearby hospital in central Florida, she assumed that which surgeon she picked wouldn’t make much of a difference—Citrus Memorial Hospital had a good reputation, after all. Unbeknownst to her, the one she picked had one of the highest rates of complications in the country, while the other two had much lower rates. Unfortunately Stiles was one of a number of people to suffer from these complications, and she died shortly after her operation from extensive internal bleeding.
Yesterday, the nonprofit investigative newsroom ProPublica published Stiles’ story, along with an extensive database of surgeons practicing in the U.S. and how often complications—like internal bleeding or infection—arise from their procedures. ProPublica calls it their Surgeon Scorecard, but it’s really a database searchable by location, hospital, type of procedure, and even individual surgeon.
This investigation, like others before it that ProPublica has conducted, addresses a much-needed gap in how the government and hospitals monitor our healthcare practitioners. Patients assume that the difference between a successful and botched procedure can come down to choosing the right hospital. But ProPublica reporters found that not to be the case; when they looked through five years’ worth of Medicare data for each of the 17,000 surgeons practicing in the United States, they found that the number of complication rates individual surgeons varied much more highly than those of hospitals.
Complications can arise for many different reasons—sometimes surgeons can just have bad luck—but often arise, in Stiles’ case, from sloppy surgeons. ProPublica looked at the number of patients that died in the hospital and the number of patients who were readmitted after 30 days for complications from the initial procedure. Final numbers are adjusted for a patient’s age and health, and make allocations for this good or bad luck that may befall a surgeon.
Results for one New York City hospital
The good news is that the overall complication rate was quite low at 2-4 percent, and only 11 percent of surgeons accounted for 25 percent of the complications. There are lots of good surgeons doing good work at institutions all over the country. But the bad news is that the systems designed to make sure that bad surgeons are being held accountable appear to be broken. Hospitals aren’t collecting enough data and are failing to spot telltale signs of systematic poor practices.
Every year 200,000 patients die unnecessarily from hospital complications, and that number has not decreased in recent years, ProPublica reports. One way to improve this might be to let patients see the data on their practitioners—a step that is “long overdue,” according to Charles Mick, former president of the North American Spine Society. The investigators hope that their database can help individual patients make the life-and-death decision about who performs their surgeries, but also provide a national push towards greater accountability.