New Jerseyans choosing a surgeon for an elective procedure have long relied on word-of-mouth and the hospital with which the doctor is affiliated.
Now they have a new tool to find out how frequently individual doctors’ patients develop postsurgical complications like infections and internal bleeding.
For example, at Holy Name Medical Center in Teaneck, the complication rate for knee surgeries ranges from 1.5 percent for the surgeon with the best rate to 4.6 percent for the one with the worst.
ProPublica, a public-interest investigative news organization, compiled and published a national database of surgeons’ complication rates, drawing on federal data for Medicare patients. The rates were adjusted to account for the age and health status of the patients that different surgeons treated.
Eight types of surgery were investigated: knee replacements; hip replacements; neck spinal fusions; lower-back spinal fusions through two different surgical techniques; laparoscopic gallbladder removals; prostate removals; and prostate resections.
ProPublica chose those surgeries because they’re typically done on healthy patients and are considered relatively low-risk.
The differences in the complication rates can be stark. For knee replacements in New Jersey, the rate ranges from 1.9 percent to 4.7 percent. For gallbladder removals, it ranges from 3.7 percent to 5.8 percent.
For others, the rates are more consistent – every New Jersey surgeons was rated as “average” in their rates of complications following prostate removals and resections.
Surgeons in New Jersey praised the availability of the data as a potentially useful tool for patients, but also cautioned that patients should do their own research and shouldn’t treat the database as their only source for making important decisions. This point was emphasized by the journalists who published the information, who said it’s best used as a starting point for making informed choices about surgeons.
Dr. Frank Alberta, a Glen Rock-based orthopedic surgeon specializing in sports injuries, welcomed the data.
“These types of outcome measures and quality measurement databases are the wave of the future and we as a group really welcome them,” Alberta said, referring to the New Jersey Orthpaedic Society, which he belongs to. He wasn’t listed in the database because he doesn’t perform the type of operations that ProPublica analyzed.
Alberta said the information could be as useful for doctors as it is for patients.
“Our primary objective is to work with our patients and come up with the safest and most effective treatment and I do believe this data does help that as long as it’s presented in a way that’s understandable and doesn’t unnecessarily alarm the patient,” Alberta said.
But Alberta added a caveat, saying that taking one number to evaluate a surgeon can’t take into account the wide variety of patients that the doctors see.
This point was reiterated by Dr. Joseph Costabile, a general and vascular surgeon with Cherry Hill-based Virtua Surgical Group.
He noted that some surgeons avoid operating on patients who present the most serious problems, while others actively aim to serve these patients. Therefore, their rates of complications may become somewhat distorted.
While a Harvard University public health expert helped ProPublica adjust the data to correct for some of these imbalances, Costabile said only the surgeons themselves fully understand the nuances that affect individual patient results.
In addition, the data only captures some of the information needed to make an informed choice. Costabile noted that a surgeon who performs unnecessary surgeries may have patients with few complications for several years, but worse long-term results.
Nonetheless, Costabile said the data will be useful.
“I’m a firm believer that patients should have as much information as they need to make an intelligent decision as to whether to have a procedure done and who to do it,” he said.
Costabile said he urges patients with questions to seek second opinions from other doctors. He also suggested that they check whether the surgeon is a member of the Medical Society of New Jersey, since these doctors made a conscious decision to join an organization that promotes professional standards. Costabile is the president-elect of the society and is scheduled to become president next May.
“The bottom line is, these websites are fine to give the consumers more information, but if they base everything on the site, I don’t think they get the full picture,” said Costabile. While he was listed in the database, there wasn’t enough data to analyze his patient’s complication rates and compare them with other doctors.
Marshall Allen, a ProPublica reporter who worked on the database and an accompanying article, noted that the data is more reliable the more procedures that a doctor performs. The database represents this by showing a bar for each doctor reflecting the statistical reliability of each number – the shorter the bar, the more reliable the data.
“This information is less conclusive with some surgeons than others, so we have shown the degree of uncertainty and we think that the patients are smart enough to understand that,” Allen said, adding that doctors and patients can use the data to jumpstart a conversation about possible complications.
“This is a starting point,” Allen said.
While some doctors – and their patients – are learning for the first time that they have high rates of complications, Allen said many surgeons have responded positively to the database.
“This is information that a large part of the medical community really does want the public to have,” Allen said. “I think it’s going to be as important to the medical community as it is patients.”