Surgical outcomes vary widely across hospitals associated with the US News & World Report Honor Roll, according to study results published in JAMA Surgery.
Researchers conducted a population-based study of patients who underwent colectomy, coronary artery bypass grafting (CABG), or hip replacement to explore variation in outcomes across hospital networks. Data were gathered from the 100% Medicare Provider Analysis and Review files that included patient age, demographic information, and comorbidities. Patients <65 years or >99 years were excluded. Additional information on hospital characteristics such as bed size or nonprofit status was obtained from the American Hospital Association Annual Survey.
Hospital networks were defined in 2 ways: by identifying hospitals named in the 2017 to 2018 US News & World Report Honor Roll, and by identifying the remaining affiliated hospitals associated with each hospital network, using the American Hospital Association databases and the Agency for Healthcare Research and Quality compendium of health systems.
Postoperative complications identified included pulmonary failure, pneumonia, myocardial infarction, deep venous thrombosis/pulmonary embolism, renal failure, surgical site infection, gastrointestinal bleeding, and hemorrhage. Deaths were identified as those that occurred within 30 days of the index operation.
Patients’ burden of comorbid diseases was similar between Honor Roll and affiliated hospitals; a total of 43,084 patients (65.1%) had 2 or more comorbidities at Honor Roll hospitals compared with 50,514 (65.6%) at affiliated hospitals. The proportion of emergent operations, however, was higher at Honor Roll hospitals (17.7%) vs at affiliated hospitals (13.4%). Both hospital networks performed a similar rate of colectomy operations (37.0% vs 35.4%); however, Honor Roll hospitals performed more CABG (29.2% vs 16.7%) and fewer hip replacements (33.9% vs 47.9%) than affiliated hospitals.
Certain patient outcomes, such as failure-to-rescue rates, were better at Honor Roll hospitals (13.3%) compared with affiliated hospitals (15.1%). Mean risk-adjusted failure-to-rescue rates were lower for Honor Roll hospitals in 12 (75%) of 16 networks. In contrast, risk-adjusted complication rates were higher at Honor Roll hospitals (22.1%) vs at affiliated hospitals (18.0%) in 9 of 16 networks. At affiliated hospitals, outcomes varied widely. In some networks, the differences in failure to rescue varied by as little as 1.1-fold, whereas in others it varied as much as 4.9-fold; readmission rates varied by from 1.1-fold to 2.8-fold, complication rates varied by from 1.1-fold to 4.3-fold, and mortality rates varied by from 1.1-fold to 4.1-fold.
“Tracking outcomes at affiliated hospitals may be an opportunity to drive changes in the overall quality, safety, and consistency of care within newly formed regional delivery networks,” the authors concluded.
Sheetz KH, Ibrahim AM, Nathan H, et al. Variation in surgical outcomes across networks of the highest-rated US hospitals [published online March 13, 2019]. JAMA Surg. doi: 10.1001/jamasurg.2019.0090