HCN News & Notes

Survival Rates for High-risk Surgeries Differ Greatly Among Hospitals

WASHINGTON, D.C. — Survival rates for high-risk surgeries diverge greatly from hospital to hospital, a new report indicates, underscoring the fact that much work still needs to be done to improve patient outcomes.

In the analysis, the nonprofit Leapfrog Group used 2013 data from 1,500 hospitals to determine predicted survival rates for abdominal aortic aneurysm (AAA) repairs, aortic valve replacements (AVR), esophagectomy, and pancreatectomy. The greatest variance in outcomes occurred with pancreatectomy, as the predicted survival rate varied from 100{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} to 81{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} between high- and low-performing hospitals, the report found. AVR procedures had the lowest survival-rate variance, ranging between 97{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} and 92{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} survival rates.

The report also analyzed survival-rate data to set quality standards for each high-risk procedure — 97.3{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} or better for AAA repairs, 95.6{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} for AVR, 91.7{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} for esophagectomy, and 91.3{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} for pancreatectomy. Based on these metrics, Leapfrog found that the percent of hospitals fully meeting the Leapfrog standard for each procedure has not significantly increased in the past five years. In the case of AAA repairs, the percent of hospitals meeting the standard has actually decreased.

“When it comes to major surgery, it’s hard to think of an outcome more important than whether you live or die,” Health Policy Professor Dr. Ashish Jha, of the Harvard School of Public Health, told Reuters. “It’s amazing there is such variability in mortality from these common surgeries, and patients should know that.”

Critics have recently renewed their skepticism of hospital-ranking systems used by Leapfrog, Healthgrades, U.S. News & World Report, and Consumer Reports, claiming these ‘best’ and ‘worst’ lists often vary widely and can confuse consumers, FierceHealthcare reported. But Leapfrog CEO Leah Binder pushed back against the critics, telling the New York Times that “there’s room for many voices” and that “we can all look at that information and judge it for ourselves.”

For its part, the recent Leapfrog report turns a judgmental eye back on hospitals, suggesting that “hospitals that have low predicted survival rates are encouraged to continue working toward better surgical outcomes, learning from others that have achieved high standards of care.”