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 For patients undergoing several common minimally-invasive abdominal
surgeries, rates of death and serious complications at hospitals
ranked high in the U.S. News and World Report annual "top 50" list
for this specialty were no better than at non-ranked hospitals,
according to the study published in JAMA Surgery.
The findings don't necessarily apply to all hospitals, since all of
those included in the analysis were affiliated with medical schools.
Still, the study does show that you don't need to worry if you can't
go to one of the top-ranked hospitals for your surgery, said study
coauthor Dr. Ninh Nguyen, a professor of surgery and chair of the
department of surgery at the University of California Irvine Medical
Center.
"Just because a hospital is on U.S. News and World Report's list
does not imply that there will be less of a chance of dying," Nguyen
said. "And that's what patients want to know."
Nevertheless, Nguyen said, patients do need to do their homework
before choosing a hospital for surgery. "You need to research the
surgeons and their teams," he explained. "You want to find out about
their annual case volumes and whether they have accreditation, if
it's offered, for the surgery."
For common advanced laparoscopic operations like the ones the
researchers investigated - bariatric surgery, colorectal surgery and
hiatal hernia procedures - you want to make sure that the surgeon
has 50 or more under her belt, Nguyen said.
U.S. News and World Report did not respond to a request for comment
on the study's findings.
To determine whether high-ranked hospitals were actually better than
others, Nguyen and his colleagues turned to a database of
information on patients hospitalized at U.S. academic centers and
their affiliated hospitals that are members of Vizient, a healthcare
performance improvement company.
The researchers focused on three common types of laparoscopic
operations performed on adults in 2017. During that year, there were
16,296 operations done at 41 USNWR top-ranked hospitals for
gastroenterology and gastrointestinal surgeries, plus 35,573
operations performed at 310 hospitals not included in the ranking.
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The researchers excluded operations that were not straightforward,
including laparoscopic surgeries that had to be converted to open
procedures.
Although three times as many surgeries were done at the top-ranked
hospitals, death and complication rates at these institutions were
no better than at non-ranked hospitals, the researchers found.
Average costs were slightly higher and patients' length of stay a
bit longer at the top-ranked hospitals, the study also found.
The good news for patients is that these days, outcomes for these
procedures are good no matter which hospital a patient chooses, said
Dr. Albert Wu, an internist and professor of health policy and
management at the Johns Hopkins Bloomberg School of Public Health in
Baltimore, Maryland. "Early in the development of this procedure,
there was great variability in complication rates," Wu added.
"The bad news is, the rankings for GI departments of hospitals don't
really work, that is, they do not help people decide where they
should go," Wu, who wasn't involved in the study, said in an email.
"We need more meaningful measures of quality, that (rate) things
people care about, such as how fast people tend to recover after
surgery and how soon they can get back to work so they can plan
ahead around their surgery."
That kind of information "should be available to all, including
potential patients as well as the hospitals themselves to motivate
them to improve or maintain their performance," Wu said.
SOURCE: https://bit.ly/313z4Do and https://bit.ly/2MyRack JAMA
Surgery, online July 31, 2019.
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