U.S. News and World Report hospital ranking and surgical outcomes among patients undergoing surgery for cancer

Abstract

Background Despite the popularity of the U.S. News and World Report (USNWR) hospital rankings among the general public, the relationship between hospital rankings and actual patient outcomes for major cancers remains poorly investigated. Methods Medicare Inpatient Standard Analytic Files were queried from 2013–2015 to assess the relationship of postoperative outcomes and Medicare expenditures among patients undergoing surgery for colorectal, lung, esophageal, pancreatic, and liver cancer at hospitals ranked in the top‐50 USNWR vs hospitals ranked below 50. Results Among 94 599 patients, 13 217 vs 81 382 patients underwent surgery at a top‐50 hospital versus a non‐top 50 ranked hospital. Other than among patients who underwent colorectal surgery, the odds of postoperative complications were lower at top ranked vs non‐top ranked hospitals (colorectal: OR, 1.46, 95% CI, 1.28‐1.65; lung: OR, 0.73, 95% CI, 0.61‐0.87; esophagus: OR, 0.70, 95% CI, 0.52‐0.94; pancreas: OR, 0.81, 95% CI, 0.70‐0.94; liver: OR, 0.85, 95% CI, 0.69‐1.04). Moreover, the odds of 90‐day mortality were lower at top ranked hospitals vs non‐top ranked hospitals (colorectal: OR, 0.59, 95% CI, 0.48‐74; lung: OR, 0.66, 95% CI, 0.53‐0.82; esophagus: OR, 0.56, 95% CI, 0.40‐0.80; pancreas: OR, 0.51, 95% CI, 0.40‐0.65; liver: OR, 0.61, 95% CI, 0.44‐0.84). Outcomes were comparable among hospitals within the top‐50 rank. Conclusion Mortality rates were lower at hospitals in the top‐50 USNWR versus non‐top ranked, yet hospitals within the top‐50 USNWR rankings had comparable outcomes.

Assessment of Magnet status and Textbook Outcomes among medicare beneficiaries undergoing hepato‐pancreatic surgery for cancer

“…22 In turn, there has been substantial attention among hospitals to obtain designations or accreditations that imply "excellence." 15 Although there are several different manners in which quality has been publicly recognized, Magnet designation is a particularly high-profile means that is often publicized by hospitals to signal that a center is "high quality." 23 In fact, Magnet status is among the quality indicators used in national hospital rankings and quality benchmarking programs such as the U.S. News and World Report of Best Hospitals.…”

“…ICD‐9/10CM diagnoses and procedure codes were utilized to identify patients having postoperative surgical complications (Table ) 16 . Readmissions were defined as admission to any hospital within 90 days after discharge 15 . Mortality was defined as death within 90 days of the index operation.…”

“…16 Readmissions were defined as admission to any hospital within 90 days after discharge. 15 Mortality was defined as death within 90 days of the index operation. Prolonged LOS was defined as LOS during the index hospitalization more than 75th percentile.…”

“…10 Previous studies have investigated the impact of Magnet status on individual outcome metrics such as complications, length-of-stay (LOS), or mortality. [12][13][14][15] More recently, several investigators have advocated for the use of composite quality metrics such as "Textbook Outcome" (TO) to define quality from a more all-inclusive patient-centered perspective. 16,17 As a composite measure, TO is easy to interpret for patients, and provides a more global assessment of care at a given center.…”

“…Similarly, an analysis of a national administrative database demonstrated no differences in mortality among critically ill children treated at Magnet versus non‐Magnet children's hospitals 10 . Previous studies have investigated the impact of Magnet status on individual outcome metrics such as complications, length‐of‐stay (LOS), or mortality 12–15 . More recently, several investigators have advocated for the use of composite quality metrics such as “Textbook Outcome” (TO) to define quality from a more all‐inclusive patient‐centered perspective 16,17 .…”