RI Hospitals With the Highest Complication Rates

Friday, July 17, 2015

Kate Nagle, GoLocal News Editor

Two hospitals and four doctors in Rhode Island were reported as having high complication rates during routine Medicare surgeries during the past five years, based on data released by non-profit media watch-dog group ProPublica.

According to the data, of eight common Medicare procedures that can be performed at least one of nine hospitals in Rhode Island, two hospitals -- Roger Williams Medical Center and South County Hospital had four doctors between them that had high adjusted rates of complications during the surgeries.

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

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The surgeries that had the highest adjusted complication rates were knee replacements, hip replacements and lumbar spinal fusions -- which according to ProPublica, one of the most common reasons for the 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.”

Prostate resections, prostate removals, gallbladder removal, and cervical spinal fusions had no surgeons reported in Rhode Island for having a high complication rate for the procedures. (See how Massachusetts hospitals fared HERE).

ProPublica's Marshall Allen and Olga Pierce reported that nationally a "small share of doctors, 11 percent, accounted for about 25 percent of the complications. Hundreds of surgeons across the country had rates double and triple the national average. Every day, surgeons with the highest complication rates in our analysis are performing operations in hospitals nationwide."

ProPublica's analysis is based on billing data hospitals submitted to Medicare from 2009-2013, and analyzed 2.3 million of the eight procedures outlined above -- and broken down the slideshow below.

What Hospitals in Rhode Island Have the Lowest Complication Rates?

In their study, Allen and Pierce wrote, “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.”

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St. Joseph's Health Services, Memorial Hospital, Rhode Island Hospital, Westerly Hospital, and Newport Hospital had no reports of surgeons with high adjusted rates of complications.

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.”

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.

Related Slideshow: RI Hospitals, Surgeons with Highest Complication Rates During Routine Medicare Procedures

ProPublica used Medicare data 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 the procedures below. ProPublica calculated complication rates for surgeons, and accounted for differences in patient health, age and hospital quality. These rates are calculated using data from Medicare records, which do not include patients with private insurance or in another program like Medicaid. (Note: Some surgeons are listed more than once. A surgeon’s rate spans all hospitals at which he or she operates and is not unique to a given hospital).

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."

Definitions (Source: Pro Publica):

Knee replacement - Replace diseased knee joint with an artificial knee.

Hip replacement - Replace diseased hip joint with an artificial hip joint.

Lumbar Spinal Fusion, Posterior Technique - The fusing of two or more vertebrae in the lower back, performed on the back portion of the spine.

Lumbar Spinal Fusion, Anterior Techique - The fusing of two or more vertebrae in the lower back, performed on the front portion of the spine.

Gallbladder Removal, Laparoscopic - Minimally invasive gallbladder removal. This is performed most commonly when gallstones are blocking the flow of bile.

Prostate Removal - The removal of the entire prostate gland via the open or laparoscopic or robotic method. Usually performed to treat prostate cancer.

Prostate Resection - The resection and removal of a portion of the prostate through the urethra. This is most commonly done because of an enlarged prostate that may be restricting the flow of urine.