Surgical Rating System
Want to be an informed consumer before you elect surgery?
A new risk calculator can help patients know their risk of death, and complications. Compiled by the American College of Surgeons (ACS), risk calculators have been used by heart specialists for years and are now being developed for other specialties, reports the Wall Street Journal.
When Kathleen Rivard was facing abdominal surgery, her surgeon at Danbury Hospital in Connecticut used the risk calculator to lay out the odds - a 1% risk of death, 18% risk of a complication such as infection at the surgical site, and an 8% risk of cardiac arrest.
Factor in her age (67), weight and blood pressure, and Rivard was assured by her surgeon that her complication rates were not out of line and could be managed.
A patient armed with information makes a better patient because they can give an informed consent based on more than an assurance from their doctor. Patients may decide to delay surgery if they don’t like the odds or until they stop smoking or lose weight.
ACS is developing the calculator for 18 other procedures based on records gathered as part of the National Surgical Quality Improvement Program and more than one million patients. The group works to reduce surgical errors and complications.
Patients should inquire whether the hospital they choose participates in a calculator risk program, which can be created for that individual patient in a matter of minutes. Expect to be able to access your calculated risk for gastric bypass, hernia repair and prostate surgery.
For example, data on 28,863 patients who underwent colorectal operations at 182 hospitals in 2006 and 2007 generated three outcomes for 30-day morbidity, serious morbidity and mortality and took into account patient age, gender, extent of disease, body mass index, shortness of breath and comorbidities such as chronic obstructive pulmonary disorder (COPD), high blood pressure, pneumonia, cardiovascular or neurologic diseases, diabetes and cancer.
Hospitals that sign onto the quality-improvement program can also compare their outcomes to a national benchmark, informing patients how their facility stacks up against others.
What appears to be omitted from consideration is the risk of avoidable medical errors such as leaving a sponge or instrument in a patient, medication errors, or delaying treatment.
More than 30 million operations are performed annually in the U.S. and it’s estimated that 2.5 to 3.5 million have experience complications, some of which are unavoidable and others that result from avoidable mistakes. The cost of surgical-site infections alone cost nearly $10 billion annually, estimates the Centers for Disease Control and Prevention (CDC).
Best Hospitals May Not Be
Besides the risk calculator, the American College of Surgeons believes that hospital ratings listed in U.S. News and World Reports “America’s Best Hospitals” as well as HealthGrades “America’s 50 Best Hospitals” are used as marketing tools and may not reflect the most favorable outcomes.
“Both the U.S. News and World Report and HealthGrades quality rating systems are frequently used for hospital marketing. Our study shows that current hospital ratings systems are no better in judging the quality of hospitals than are procedural volumes,” according to Nicholas Osborne, MD, Robert Wood Johnson Clinical Scholar, University of Michigan, Ann Arbor.
Patients can also visit the European system for risk assessment, euroscore.org to calculate their risks for cardiac surgery, using a free program from the European System for Cardiac Operative Risk Evaluation, widely used in European hospitals. #