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Here’s what you should know about choosing the right surgeon

A new report by ProPublica sheds light on the importance of choosing the right surgeon, especially when it comes to elective surgery. The non-profit news organization analyzed the complication rates of 17,000 surgeons nationwide and released its findings to the public. Olga Pierce of ProPublica joins Hari Sreenivasan for more detail.

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  • HARI SREENIVASAN:

    Now to the results of the new report by ProPublica about the importance of choosing the right surgeon and what can happen if you don't do your research, especially when it comes to elective surgeries. Past studies have estimated as many as 200,000 patients die in U.S. hospitals every year due to preventable errors and complications during their stays. ProPublica analyzed the complication rates of 17,000 surgeons nationwide and released its findings this week.

    Joining me now is the co-author of the report, ProPublica's Olga Pierce. You worked on this with Marshall Allen. So, first of all, what did you look at and what did you find?

  • OLGA PIERCE:

    So we started with a pretty simple journalistic question: if you're a surgeon, how many cases did you do and what became of your patients? Did they die in the hospital, or were they so sick or in so much pain that they had to come back within 30 days?

  • HARI SREENIVASAN:

    So who tracks this, and where do you find the information?

  • OLGA PIERCE:

    Really for patients right now, there's almost no information publicly available. We've published the results for 17,000 surgeons online. But really, there's almost no systematic tracking in American healthcare of these types of problems.

  • HARI SREENIVASAN:

    So we're not talking about all surgeries. You chose to focus on a specific set. Why? And what surgeries?

  • OLGA PIERCE:

    So we looked at elective surgeries that are commonly done on healthy patients, mostly because we wanted to sort of get an apples-to-apples comparison for the surgeons in our data. So we looked at three types of spinal fusion, total knee replacements, total hip replacements, two types of prostatectomy, and gall bladder removal.

  • HARI SREENIVASAN:

    And these were ones that were covered by Medicare.

  • OLGA PIERCE:

    Yes. So there are a couple of important limitations of the data we've published. One is that because of the way American health care works, really the only comprehensive national data is in Medicare. So if a surgeon did a lot of cases outside it, we just can't see them.

    Also, you know, there are complexities in cases that we can't really see in the records we have. So that's another thing to keep in mind.

    And finally, you know, it's sort of like investments, right? Past performance doesn't necessarily guarantee future performance.

  • HARI SREENIVASAN:

    So if I typed a name of a surgeon into this scorecard, this database that you've built, what am I likely to find?

  • OLGA PIERCE:

    So the first thing is how many cased did someone do in Medicare? And then how many of their patients died or had a complication within 30 days? And then on top of it, to provide extra context, we give an adjusted rate that takes into account things like what is the quality of the hospital where the surgeon does surgery, and are your patients especially complex or something like that.

  • HARI SREENIVASAN:

    All right. Most people think about the hospital. They don't necessarily even know that this data point exists about the specific surgeon, right? So I mean, some of the surgeons are going to come back and say, listen, I deal with the most complicated. I get somebody's leftovers, and I have to deal with this. And maybe there's a higher proportion of my patients that die.

  • OLGA PIERCE:

    Yeah, so we've done everything we've could within the limits of the data to take those things into account. We screened out all kinds of patients who looked unusual in some way; they had a strange diagnosis or something like that. And then on top of it, we did sort of a statistical magic to kind of adjust for people who had what appeared to be extra-complex patients.

  • HARI SREENIVASAN:

    So is there a certain level of almost acceptability in the error rate that's happening in medicine today?

  • OLGA PIERCE:

    I think so. I think at many hospitals, they sort of say, you know, what is a normal complication rate? Are we at it? Great. But in addition, you know, as you travel across the country investigating cases where someone seemed to be outside the norm, the first question we got almost every time from hospitals and surgeons was how did I do? Because they don't know.

    And I think if anything is taken away from our reportage, I think that's one of the most important things: that these things are not being measured. And because of that, we're losing out on not just important information for the public, but there's a real opportunity to learn and improve if we figure out who is doing the best.

  • HARI SREENIVASAN:

    OK. And you also had an interesting finding, which was that a small hospital where there's not that much staff actually had lower rates of complication. That seems almost counterintuitive versus if I go to a big hospital in New York with lots and lots of tools and people.

  • OLGA PIERCE:

    Yes, I think the conventional wisdom here was that there are sort of good hospitals and bad hospitals. And if you choose a good hospital based on reputation or something else, there's sort of a reasonable expectation at that hospital has sort of screened out any surgeons who are sub-par.

    That's really not what we found in our research. We found that there are great surgeons in places you wouldn't expect, and also surgeons that appear to be problematic at really elite institutions.

  • HARI SREENIVASAN:

    And how does that distribution break down? Is it a small number of surgeons that account for a high number of complications?

  • OLGA PIERCE:

    Sure. What we found was that about 10 percent of surgeons accounted for a quarter of all complications.

  • HARI SREENIVASAN:

    And how do you – how do you kind of do the math? If you're the person that's going to go in for a hip replacement or a knee replacement, what are the questions you should be asking of both the hospital and the surgeon?

  • OLGA PIERCE:

    Sure. I think the first question is, you know, when a surgeon says this surgery is low-risk, it has a two percent complication rate, ask them, "Well, what is your rate? What do you do? And do you even know?" And a reasonable expectation is that they would be able to answer those questions.

  • HARI SREENIVASAN:

    And you also found that, was it in 63,000 Medicare patients suffered serious harm, 3,400 died after going for procedures like these?

  • OLGA PIERCE:

    Yeah. There was quite a high count of people who had serious problems. And so another thing to keep in mind is that it's very important to do your research before you go in for one of these surgeries. Not just using our tool, but also do all the things you would normally do. Ask your general practitioner, ask someone who has also had the surgery, those sorts of things.

  • HARI SREENIVASAN:

    All right. You've pored over millions of records for this. You looked at five years' worth of data in all these different surgeries.

    Olga Pierce from ProPublica, thanks so much for joining us.

  • OLGA PIERCE:

    Oh, thank you.

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