Choosing the right hospital for high-risk surgery can save your life

Choice of hospital can be a matter of life and death when it comes to high-risk surgeries, due to wide variances in survival rates across U.S. hospitals. As part of its 2014 Hospital Survey, The Leapfrog Group released a report titled, Predicting patient survival of high-risk surgeries. The report, analyzed by Castlight Health using Leapfrog’s 2014 Hospital Survey Results, is an in-depth examination of the survival rates of four high-risk surgeries.

High-risk surgeries

The four surgeries included in the survey are:

  • abdominal aortic aneurysm (AAA) repair—surgery to treat an enlarged abdominal aorta, the major blood vessel that supplies blood to the body;
  • aortic valve replacement (AVR)—heart surgery that treats problems with the heart’s aortic valve;
  • pancreatectomy—surgery to remove all or part of the pancreas to treat several conditions, such as benign (non-cancerous) pancreatic tumors, pancreatic cancer, and pancreatitis; and
  • esophagectomy—surgery to remove all or part of the esophagus, usually done to treat cancer

These were chosen for the report because each surgery is both common and high-risk.

Findings

Pancreatectomy has the most significant variance in survival rate by hospital, at 19 percent; predicted survival rates range from 81 to 100 percent.

Esophagectomy has an average survival rate of 90 percent with a variation by hospital of 88 to 98 percent.

AAA repair has a 13 percent variation in predicted survival rates, which range from 85.7 to 98.9 percent. The report notes that this variation has increased since 2013.

AVR had the fewest number of hospitals meeting Leapfrog’s standard, with only 17 percent of hospitals that perform at least 120 AVRs per year reporting a risk-adjusted average mortality rate that’s better than expected given the type of hospital and its patients; or having a predicted survival rate of 95.6 percent or better.

Call to action

Although all surgeries carry some amount of risk, the study found that “it is evident that some hospitals in the U.S. simply provide safer, higher-quality care.” To ensure that patients enjoy the best possible surgical outcomes, hospitals and other stakeholders can take a number of recommended steps, including:

  • Hospitals that have low predicted survival rates are encouraged to continue working toward better surgical outcomes—learning from others that have achieved high standards of care.
  • Employers should urge hospitals to complete the Leapfrog Hospital Survey and should encourage their employees to choose hospitals that provide the highest levels of surgical care.
  • Patients and families that need surgical care services are encouraged to consult the Leapfrog Hospital Survey results before choosing a hospital for their procedure.

Leapfrog President and CEO Leah Binder said, “Every year, millions of Americans undergo surgery, and this report clearly demonstrates that the choice of hospital is one of the most important decisions a patient can make. We strongly encourage consumers to examine their local hospitals’ performance on these high-risk procedures, as the data on survival rates enables patients to gauge their likelihood of surviving each procedure at a given hospital. The difference in lives lost from hospital to hospital can be substantial and this data can’t be accessed anywhere else.”