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Elizabeth Cooney is a health reporter for the Worcester Telegram & Gazette.
Boston Globe Health and Science staff:
Karen Weintraub, Deputy Health and Science Editor, and Gideon Gil, Health and Science Editor.
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Wednesday, July 11, 2007
Surgeon rankings have unintended consequences, doctors say
Dr. Thomas H. Lee knows the headline he wrote is provocative: "Is Zero the Ideal Death Rate?"
"If you are being ranked, you may walk away from a patient who’s very sick, even though that patient may be at high risk for surgery but even higher risk with medicine" as treatment, he said in an interview. "When so few patients can swing things for you being ranked, we’re worried about that effect on the decision-making process."
Lee, along with co-authors Dr. David F. Torchiana, a cardiac surgeon at Massachusetts General Hospital, and Dr. James E. Lock, an interventional cardiologist at Children’s Hospital Boston, say that reporting on cardiac surgery by institution makes sense, with individual reports available only to those hospitals. Massachusetts recently joined New York, New Jersey and Pennsylvania in publicly reporting death rates for individual cardiac surgeons.
Two elements make individual reports undesirable, they said. The first problem is that risk-adjustment methods intended to account for how sick a patient is do not include variables such as socioeconomic status. The second problem is the small sample size. If the average death rate after coronary artery bypass surgery is 2 percent, one or two deaths among the 200 operations a surgeon performs can make a large difference in that surgeon’s ranking, the authors say.
"I worry about having a patient with diabetes who’s doing very poorly. They may have a 20 percent mortality rate with surgery but an 80 percent mortality rate without surgery," he said. "I don’t want to have to beg surgeons to operate."