Power Outage—Inadequate Surgeon Performance Measures Leave Patients in the Dark

Creating Individual Surgeon Performance Assessments in a Statewide Hospital Surgical Quality Improvement Collaborative

“…These findings suggest that concerns over the use of physicianlevel outcomes comparisons based on small sample sizes are warranted. 6,7,16 The proportion of total variation attributable to the surgeon level was greatest for SSI (4.5% for the physician-only level, 7.4% for physician-within-hospital), but was still well under 10%. The median reliability level for each outcome was below 0.1, which suggests provider differences were mostly the result of statistical noise.…”

“…12,13 Criticisms of these efforts include the choice of outcomes measures that either lack validity or are misnamed, inadequate risk adjustment, provider case volumes that are too small and result in low reliability of the estimates (ie inability to distinguish provider performance), and limitations inherent in administrative data (eg inaccurate provider assignment to claims, lack of detailed clinical data), which are frequently used. 10,[14][15][16][17] Hall and colleagues 5 analyzed historical data covering 3 years (2002 to 2004) on 197 surgeons at 9 hospitals from the American College of Surgeons (ACS) NSQIP in an attempt to profile individual surgeons from clinical registry data. Using 30-day postoperative patient complication outcomes as the profiling metric, they found that depending on the type of complication, some differentiation of provider performance was possible.…”

The Effect of Feedback on Surgeon Performance: A Narrative Review

“…Many studies argue for the necessity of surgeon-level analysis and reporting [ 22 , 23 ]. The ProPublica scorecard was one such tool designed in hopes of tracking surgeon performance, but significant design flaws have wrought concern regarding this particular modality [ 24 – 27 ].…”

“…The overwhelming critiques focus on the chosen factors contributing to their reported “adjusted complication rates” (any hospital readmission or death within 30 days of surgery) and the factors that are missing (complications without readmission, any complications >30 days, complications during the index hospitalization). The authors argue for the amelioration of this tool, as it represents an opportunity to drive quality improvement and aid in patient selection of provider [ 22 , 24 , 28 ].…”

Association Between Board Certification, Maintenance of Certification, and Surgical Complications in the United States

“…The analysis included 1 884 842 procedures performed by 14 598 surgeons, of whom 9387 (64%) were orthopedic surgeons, 2476 (17%) were general surgeons, 1663 (11%) were urologists, and 1072 (7%) were neurosurgeons ( [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40]. Seventeen percent of surgeons were affiliated with a for-profit hospital, 50% with an academic hospital (49% of orthopedic surgeons, 46% of urologists, 59% of general surgeons, and 60% of neurosurgeons), and 35% worked in rural settings.…”