New Data Indicates Survival Rates for High-Risk Surgeries Vary by Hospital

Andrew Kitchenman | March 12, 2015 | Health Care
Leapfrog Group report can inform decisions on where to go for surgeries, but doctors, other factors also matter

heart surgery
A person’s chances of surviving certain high-risk surgeries vary depending on the hospital, according to newly available data.

New Jerseyans weighing where to go for one of four types of surgeries can turn to a Leapfrog Group report released today, which is part of a broader effort to increase hospital quality and inform patients’ decisions.

The report calculated patients’ odds of surviving based on 2013 data reported by the hospitals. Both the survival rates for 2013 and the number of each type of surgery were factored into each hospital’s predicted survival rate, which was also adjusted for the health of the patients.

While Leapfrog Group officials said the data would be useful to those making decisions about where to have surgeries, it also should be used with caution. The particular surgeons are essential to the success of a procedure, and the annual data for each hospital can be based on small numbers.

The four procedures considered in the report were: abdominal aortic aneurysm repair, which treats an enlarged vessel that supplies blood to the body; aortic valve replacement, a heart surgery; surgery to remove all or part of the pancreas; and surgery to remove all or part of the esophagus.

These surgeries were chosen because they’re relatively common, high risk, and their measurement has been endorsed nationally by organizations seeking to improve healthcare quality.

“There is such tremendous variation in hospital performance,” said Erica Mobley, a Leapfrog Group spokeswoman.

For abdominal aortic aneurysms, the top New Jersey performer was Morristown Medical Center, where patients’ predicted survival is 98.7 percent. The lowest was Capital Health Regional Medical Center in Trenton, at 94.8 percent, which was below the national average of 97 percent but well above the worst hospital nationally, which was at 86 percent.

For aortic valve replacements, eight New Jersey hospitals were rated as having better-than-average predicted survival odds, while three — Cooper University Health Care in Camden, Newark Beth Israel Medical Center, and Our Lady of Lourdes Medical Center in Camden — were worse than average. The report didn’t provide more detailed data for most hospitals for this surgery.

For pancreas removal, Cooper University Health Care had the highest predicted survival odds, at 99.4 percent, while three hospitals tied for the worst, at 86.3 percent: Inspira Medical Center Vineland, JFK Medical Center in Edison, and Jersey City Medical Center. The national average was 91 percent, while the worst performer nationally was at 81 percent.

For esophagus removal, Robert Wood Johnson University Hospital in New Brunswick had the best predicted survival odds, at 94.1 percent, while six hospitals were tied for the worst, at 88.4 percent: Englewood Hospital and Medical Center; Jersey Shore University Medical Center in Neptune; JFK Medical Center; Palisades Medical Center in North Bergen; University Medical Center of Princeton at Plainsboro; and Virtua Memorial Hospital in Mount Holly. The national average was 91 percent.

Of 71 New Jersey hospitals asked to participate, 62 submitted data. But many of those didn’t have enough surgeries to be included in one or more categories.

“What you’re looking for is a hospital that’s performing a really high volume,” since more-experienced staffs usually perform better, Mobley said, adding that there’s a benefit to having many hospitals without data to report. “We want hospitals that don’t have a high volume to be referring patients to a hospital that does.”

Leapfrog Group officials said hospitals with lower rates could learn from higher performers.

“Hospitals need to be following best practices for the performance of these procedures,” and ensure that surgeons — as well as the staff members who help patients with followup and recovery — are well trained, Mobley said.

While a goal of releasing the report is to improve hospital performance nationally, the 2013 numbers didn’t reflect an upward trend. For three of the surgeries, predicted survival odds were relatively flat, while the share of hospitals meeting Leapfrog Group standards actually dropped in 2013 for abdominal aortic aneurysms.

“We’re also using this to educate the public in general that this information exists and that there is this tremendous variation, so they should be looking up a hospital before they have these procedures done,” Mobley said.

Amanda Melillo, a research associate with the New Jersey Health Care Quality Institute, said institute officials are hopeful that publicly reporting the data will contribute to improvements.

“However, we think you need to be careful drawing state-based rather than national conclusions given the relatively small number of these procedures,” Melillo said, adding that the institute appreciated the openness of the hospitals that reported their data. The institute works with the Leapfrog Group to encourage hospital participation.

“We think it demonstrates their commitment to transparency and improvement,” she said.

The Leapfrog Group is a Washington, D.C., nonprofit started by employers with the goal of improving hospital quality. Castlight Health, a San Francisco healthcare data company, analyzed the information. The report is the second of a series of six, which began last month with a report on maternal health.