More Public Reporting of Surgeon Outcomes Could Reduce Patient Risks: JAMA Editorial

A prominent doctor has written an editorial calling for better reporting of surgeon-level outcomes and mortality rates at hospitals nationwide, providing the public better access with surgical success records of individual surgeons. 

The editorial was written by Dr. Ashish K. Jha, a professor of International Health and Health Policy at the Harvard T. H. Chan School of Public Health, and was published last week in the Journal of the American Medical Association (JAMA).

Jha points out that the debate over surgeon-level mortality reporting began nearly 30 years ago, and continues to this day. At issue is whether mortality reporting should occur at the hospital level, meaning the data is limited to surgical mortality for the hospital as a whole, or whether it should report on the success and failure of each individual surgeon.

“The evidence on whether the public or payers use these data to select high performers suggests that for the most part, they do not,” Jha wrote. “But we do know that hospitals and physicians are paying attention. And there is widespread hope that with increasing consumerism in health care and with more patients paying out of pocket for their care, they will increasingly look for these kinds of reports.”

Jha noted that arguments against surgeon-level reporting have been gaining traction, with critics arguing that some surgeons conduct too few surgeries for the individual data to be reliable. They also argue that surgeons may begin avoiding more difficult surgeries in order to keep their success level high.

Jha wrote that the low number of surgeries, resulting in a low sample size, can be addressed by simply looking at the surgeon’s record over the course of several years. He also pointed out that a number of studies have failed to find that surgeons shirk away from taking on difficult operations for fear of their patient mortality rate increasing.

“When people seek advice on where to go for surgical care, they ask about the best surgeon for them,” he wrote. “Telling the public that the surgeon doesn’t matter, that only the choice of hospital matters, is neither useful nor accurate. And it won’t work, because for patients, undergoing surgery creates deep anxiety, and trusting the judgment of an individual surgeon is paramount.”

Jha called for efforts to expand efforts to publicly report performance on the surgeon level, saying that the surgeons, who are the persons most influential in the surgical process, should remain accountable to the public.