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Research Letter |

Comparing Publicly Reported Surgical Outcomes With Quality Measures From a Statewide Improvement Collaborative

Gregory B. Auffenberg, MD1; Khurshid R. Ghani, MBChB, MS1; Zaojun Ye, MS1; Apoorv Dhir, BBA1; Yuqing Gao, MS1; Brian Stork, MD2; David C. Miller, MD, MPH1
[+] Author Affiliations
1Department of Urology, University of Michigan, Ann Arbor
2West Shore Urology PLC, Muskegon, Michigan
JAMA Surg. 2016;151(7):680-682. doi:10.1001/jamasurg.2016.0077.
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This study examines whether surgeon-specific complication rates reported in the Surgeon Scorecard correlate with several perioperative quality measures.

The recent release of a Surgeon Scorecard has accelerated debate around the merits of publicly reporting surgical outcomes.1 Based on Medicare claims from 2009 through 2013, this scorecard provides the public with surgeon-specific complication rates for 8 elective procedures performed by nearly 17 000 surgeons. While the intent of this effort—greater transparency leading to better outcomes—is laudable, many contend that the scorecard is misleading because it provides data for a single outcome measure that may not correlate well with other quality metrics.

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Figure.
Comparison of Surgeon-Specific Perioperative Outcomes From the Surgeon Scorecard and Michigan Urological Surgery Improvement Collaborative

The complication rate for the Surgeon Scorecard (x-axis) was a composite measure of in-hospital mortality or related hospital readmission within 30 days of surgery, adjusted for patient age, comorbidity, and surgical approach (ie, open vs robotic). The models for the Michigan Urological Surgery Improvement Collaborative (y-axis) are adjusted for patient age, comorbidity, and surgical approach (ie, open vs robotic) and account for the clustering of outcomes within surgeons. A, Estimated blood loss. B, Surgical margin status for patients with organ-confined disease (pathologic stage = T2). Margin data are reported for 34 of 35 surgeons in the collaborative. C, Pelvic complications, defined by the Michigan Urological Surgery Improvement Collaborative as the occurrence of intraoperative rectal injury or the requirement for urinary catheter or pelvic drain for greater than 16 or 2 days, respectively. Data for this measure have been collected since April 1, 2014. D, Thirty-day rate of readmission or mortality.

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