Top Ranking Hospitals Not Linked to Improved Gastrointestinal Surgery Outcomes: Study

Undergoing gastrointestinal surgery at a top-ranked hospital does not appear to result in any better outcomes or reduce the risk of death, according to the findings of a new study.

Researchers from the University of California’s Irvine Medical Center report that while the top-ranked hospitals for gastrointestinal surgery according to U.S. News and World Report do perform more of the procedures overall, the outcomes for patients were not better when compared to non-ranked facilities. The findings were published this week in JAMA Surgery.

The U.S. News and World Report (USNWR) conducts an annual ranking of what it deduces to be the top 50 best hospitals for various medical specialties. It is widely viewed as an authority on surgical care and hospital quality, and the list is often used by patients to choose a hospital when considering treatment.

Researchers focused on hospitals included in the U.S. NWR ranking of the best hospitals performing gastroenterology and gastrointestinal surgical procedures. They wanted to determine if being a top-ranked USNWR hospital was linked to better patient outcomes, lower rate of death, or lower risk of complications.

More than 351 academic health centers and community affiliates were compared across 52,000 abdominal surgeries, including bariatric, colorectal, and hiatal hernia surgeries.

According to the findings, having gastrointestinal surgery at a top-ranked hospital was not linked to a lower risk of death or serious complications. There were no statistically significant differences in morbidity or in-hospital mortality between hospitals which received a high ranking and those which did not.

Top-ranked hospitals conducted more than 35,000 surgeries, compared to non-ranked hospitals that only conducted about 16,000 operations. Top-ranked hospitals had an annual case volume of 397 compared with 114 at non-ranked hospitals; more than three times higher.

However, while the outcomes were not improved, having surgery at a top-ranked hospital was linked to a higher cost and a longer hospital stay.

Samer G. Mattar of the Bariatric, Metabolic and Endocrine Center at Swedish Hospital Seattle, wrote an accompanying editorial, noting that the hospital rankings may be more of a benefit to hospitals’ bottom lines, than they are to patients.

“Although, one presumes, the original intention of these efforts was to inform patients on the most appropriate regional or national health care facility that would address their specific needs, the main benefactors of these rankings appear to be the marketing administrators within the institutions that occupy an elevated position on the list,” Mattar wrote. “The annual publication of hospital rankings is invariably followed by robust, energetic, and pervasive advertising by hospitals that have been endowed a higher ranking in 1 or more specialties, resulting in increased financial disbursement that, in turn, will need to be recouped through higher cost of health care delivery.”

Mattar noted that the spending may be wasteful if there is no improved experience for patients and if it leads to them improperly interpreting the rankings.