Home E-Weekly August 29, 2017

Why Surgeon-Specific Outcomes Matter

Published: August 28, 2017

TEAM LEADER Surgeons shoulder the ultimate responsibility of post-op results.

There are plenty of valid reasons to avoid naming names when publishing surgical outcomes data, but moving away from surgeon-level reporting would be a critical mistake, according to Ashish K. Jha, MD, MPH, a professor of international health and health policy at the Harvard T. H. Chan School of Public Health in Boston, Mass.

Dr. Jha, in an opinion piece published in JAMA, addresses the arguments against publically reporting surgeon-specific quality outcomes:

  • Small sample sizes. Critics believe the surgical volume of individual surgeons is too low to draw reliable conclusions about the care they provide, but Dr. Jha argues that a surgeon's performance can be aggregated across multiple years and across a range of procedures. In addition, he says outcomes data can be reported with confidence intervals to fully disclose statistical limitations.
  • Risk-adverse scheduling. Some experts assume the practice could cause surgeons to avoid taking on the most difficult cases, but Dr. Jha says this concern is based on weak clinical evidence and has never been definitely proven.
  • Share responsibility. Perhaps the strongest argument against reporting surgeon-specific outcomes is that surgeons work as part of surgical teams comprised of skilled individuals who play important roles in the quality of delivered care. Dr. Jha acknowledges the importance of teamwork in the OR, but says surgeons are ultimately responsible for ensuring effective communication among the nurses and techs they work with.

Ultimately, says Dr. Jha, patients who are being asked to pay more out of pocket for their surgical care want access to performance data when trying deciding which surgeon is best, especially in the context of increasing consumerism in health care.

"Telling the public that the surgeon doesn't matter is neither useful nor accurate," says Dr. Jha. "Consumers would reject reports that only showcase institution-level data because they would find it less useful.

"If the goal is to improve surgical care," he continues, "we must ensure that the person most influential in the process remains accountable for its outcome."

Daniel Cook

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