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Redefining the “Honor Roll:” do hospital rankings predict surgical outcomes or receipt of quality surgical care?

  • Rittal Mehta
    Affiliations
    Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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  • Anghela Z. Paredes
    Affiliations
    Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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  • Timothy M. Pawlik
    Correspondence
    Corresponding author. Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, Professor of Surgery, Oncology, Health Services Management and Policy, The Ohio State University, Wexner Medical Center, 395 W. 12th Ave, Suite 670, USA.
    Affiliations
    Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Published:November 26, 2019DOI:https://doi.org/10.1016/j.amjsurg.2019.11.029

      Highlights

      • Hospital rankings are often used to guide a patient’s decision on which hospital may be best equipped to manage their care.
      • Hospital’s honor roll position was not associated with differences in patient outcomes following surgical intervention.
      • Caution should be used when attempting to associate rank-position and clinical outcomes or quality of care.

      Abstract

      Background

      Hospital ranking systems are often used by individuals to inform choice around which healthcare system may be best equipped to manage their care.

      Methods

      The 2013–2015 100% Medicare Inpatient and Outpatient SAFs was utilized to identify patients who underwent surgery (AAA repair, CABG, THA, TKA and lung resection) at one of the top-20 hospitals ranked by USNWR.

      Results

      On multivariable linear regression analysis, after controlling for clinical and hospital level factors, rank position among the top 20 USNWR hospitals was not associated with the proportion of patients who experienced a complication (β = 0.167), failure-to-rescue (β = 0.277), 90-day readmission (β = 0.186) and 90-day mortality (β = 0.033)(all p > 0.05). Similar trends were observed among each surgical procedure type, as well as even among all top 50 USNWR ranked hospitals (all p > 0.05).

      Conclusion

      Rank position among hospitals within the USNWR "honor roll" was not associated with differences in patient outcomes following surgical intervention. Patients and hospitals need to exercise caution when placing weight on rank-position among hospitals as a means to discriminate clinical outcomes and quality of actual patient care.

      Keywords

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