A new tool called “Surgeon Scorecard” has been developed and just made available by the not-for-profit consumer advocacy organization ProPublica.
What this tool does is it allows anyone to look at the adjusted complication rates associated with eight different types of common surgical procedure carried out at hospitals across America by literally tens of thousands of surgeons — who are identified by name! There is little doubt that some surgeons in particular, and the surgical community in general, are not going to be entirely happy about public access to data like these.
Here are the procedures studied:
- Knee replacement surgery
- Hip replacement surgery
- Gall bladder removal (laparoscopically)
- Lumbar spinal fusion (posterior technique)
- Lumbar spinal fusion (anterior technique)
- Prostate transection (a transurethral resection of the prostate or TURP)
- Prostate removal (a radical prostatectomy)
- Cervical (neck) spinal fusion
This tool is based exclusively on Medicare-related data from 2009 to 2013, and therefore on results from Medicare patients, so if a particular surgeon operates on low numbers of Medicare patients his or her data will not be available through this system. On the other hand, one can reasonably expect that surgeons who have low numbers of complications on Medicare patients would also have low numbers of complications on non-Medicare patients for a specific type of procedure.
Second, the developers did try to take account of patient co-morbidities in developing this database. They screened each patient’s record for signs of health problems other than the actual problem being treated surgically (e.g., obesity and diabetes) and then assigned each patient a health score before calculating an individual surgeon’s adjusted complication rate.
Perhaps even more interestingly, the tool can be used to see what the general level of complications is at particular hospitals — and that is liable to have greater validity than the data for any one individual surgeon conducting any one type of procedure. A hospital with a relatively high complication rate “across the board” clearly has a problem!
Basically, you can use the Surgeon Scorecard to look at the complication rates at specific institutions (e.g., Johns Hopkins in Baltimore) or specific surgeons (e.g., Alan Partin, MD, the Chairman of the Urology Department at Johns Hopkins). We have called out Johns Hopkins for a reason. The Johns Hopkins radical prostatectomy data deals with 11 of their surgeons by name. You will see that Dr. Partin has the lowest complication rate among the group and that another surgeon has a much higher complication rate than his peers. This is a point emphasized by ProPublica in their information about the release of this database. However, what we do need to be very cautious about is the question of whether the surgeon with the high complication rate is actually operating on similar patients to the other Johns Hopkins surgeons. If that surgeon is, for example, very deliberately focusing on surgical treatment of high-risk patients and/or men with radiation-recurrent prostate cancer, then it would be completely reasonable to expect him to have a much higher complication rate than his peers. We suspect that this may, in fact, be the case at Johns Hopkins.
So … yes, this is a very interesting tool for patients and others to be able to use to assess the skill levels of prostate cancer surgeons … but, you can’t take these data as some sort of absolute truth because they need to be looked at in context.
Here’s how I think the average patient can best access the tool:
- Go to the main web page for the Surgeon Scorecard.
- To look for hospitals in your general area using the “Find New Me” tab. For example, enter “Baltimore, Maryland” into the space where it ask for “Surgeons and Hospitals Near My Location”
- Select “Prostate removal” as the surgery type and click the search icon. The resulting page will show you links to five hospitals in the Baltimore area for which data are available.
- Click on the link to Johns Hopkins Hospital and you will get to this page, which gives you information on complication rates for six different types of surgery carried out at Johns Hopkins.
- Click on the link to Prostate removal (as opposed to Prostate resection, which means a TURP) and you will get to this page, which shows the complication rates for radical prostatectomy for the 11 surgeons at Johns Hopkins for whom data are available.
You can carry out similar searches for any region in the USA or you can also search by individual physician or by individual institution.
Again, we are going to emphasize that this tool is interesting but needs to be used with care. It will probably be of great value to some patient support group leaders in looking at the complication rates for surgeons in their areas of the country … but one has to be aware that there may be reasons for “outlier” results like the one mentioned above.
For those who are interested in reading more about this system and how ProPublica created it, here are some relevant links:
- Click here to see the story ProPublica used to promote this tool to the media and to consumers.
- Click here to see how ProPublica actually created the tool and understand the data on which it is based.
- And there is also a list of “FAQs” for those who may have questions about the tool and the data used to create it.