August 1, 2019 / 8:19 PM / 3 months ago

For some surgeries, hospital rankings not tied to better outcomes

(Reuters Health) - When it comes to common gastrointestinal operations, such as weight loss surgery, a U.S. hospital’s ranking may not equate with better outcomes, a new study suggests.

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.

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: bit.ly/313z4Do and bit.ly/2MyRack JAMA Surgery, online July 31, 2019.

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