MA Hospitals with Highest Complication Rates During Routine Procedures

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Wednesday, July 15, 2015

Patrick Sargent, GoLocalWorcester Contributor

Based on data released by non-profit, media watchdog group, ProPublica, UMass Memorial Hospital and Saint Vincent’s Hospital in Worcester have relatively low rates of complications for routine procedures compared to other hospitals in Massachusetts.

According to the data, of the seven procedures that can be performed at UMass Medical Center, and six at Saint Vincent’s Hospital, analyzed by ProPublica, the hospitals have a low to medium rate of complication in all but one.

SEE SLIDES BELOW: MA Hospitals and Surgeons with Highest Complication Rates

The one procedure with a high complication rate in both hospitals is lumbar spinal fusion performed on the front portion of the spine (anterior technique). According to ProPublica, one of the most common reasons for this surgery “is the narrowing of the space between the vertebrae, which puts pressure on the spinal cord and nerves, causing pain. It can also be done because of disc degeneration or a condition where one bone in the back slides forward over the bone below it.”

The data shows that between 2009 and 2013, Dr. Gerald McGillicuddy, who works at both hospitals, performed the procedure 32 times - with a 5.8% rate of complication.

Only four hospitals in the state had a least one surgeon with a high rate of complications while performing this type of lumbar spinal fusion. The others were Newton - Wellesley Hospital and Lahey Clinic Hospital in Burlington.

The procedures with the lowest rates of complication at Saint Vincent’s were for the posterior technique of lumbar spinal fusion (performed on the back portion of the spine) and for knee replacements.

UMass Memorial had the same success with the same procedures as Saint Vincent’s, but performed exceptionally well when it came to hip replacements.

Out of 312 hip replacements performed at UMass, only 2.5% resulted in any kind of complication - putting it in the top five of the 52 hospitals in the state for hip replacements (a remarkable number given that 25% of hospitals in the state had at least one surgeon with a high complication rate for said procedure).

What Hospitals in Massachusetts Have the Highest Complication Rates?

In their study released on Tuesday, Marshal Allen and Olga Pierce of ProPublica write, “As would be expected, overall complication rates were relatively low, ranging from 2 percent to 4 percent, depending on the type of surgery. But experts who reviewed ProPublica’s results say they strongly suggest that the typical surgeon’s rate can and should be significantly lower. The evidence: Some 756 surgeons who each did at least 50 operations did not record a single complication in the five years covered by the analysis. Another 1,423 had only one.”

ProPublica looked at eight procedures done in Mass. hospitals (both lumbar spinal fusions, knee replacement, hip replacement, cervical spinal fusion, gallbladder removal, prostate removal and prostate resection.

The hospitals that made the lists for highest rate of complications for more than one of these procedures included Massachusetts General Hospital, Cape Cod Hospital, Newton-Wellesley, Beth Israel Deaconess Center (Boston), and Hallmark Health System.

Dr. Thomas Lee, a professor at the Harvard School of Public Health in Massachusetts, told ProPublica, “I think the methodology was rigorous and conservative. I would be surprised if any experienced clinician challenged the basic finding, which is that there is real variation among surgeons. A critical step toward improving care is to recognize that there are opportunities to improve. I think transparency on quality is a powerful tool, and, frankly, I prefer that to financial incentives as a way to drive competition and improvement on quality.”

See slides below to see what procedures resulted in complications at these hospitals.

Where Do the Complication Rates Come From?

ProPublica used billing data hospitals submitted to Medicare from 2009-2013 to identify cases where a patient died in the hospital or had to be readmitted within 30 days for a problem related to one of these elective procedures. Complication rates were then calculated for surgeons, while accounting for differences in patient health, age and hospital quality.

These rates do not include patients with private insurance or in another program such as Medicaid. Like Dr. McGillicuddy, every surgeon is rated not by the hospital they work in, but by the collective times they performed each procedure.

Each procedure had to be performed in a hospital at least 20 times in order for it to meet the study’s requirements. The adjusted complication rate is measured by "the rate of complications, adjusting for several variables, including performance of the hospital and the health and age of surgeon's patients."

For Saint Vincent’s Hospital, the hospital did not meet the volume requirement for gallbladder removal or cervical spinal fusion. UMass Memorial also did not meet the requirement for cervical spinal fusion.

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Related Slideshow: MA Hospitals and Surgeons with Highest Complication Rates During Routine Procedures

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