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Original Investigation
March 13, 2019

Variation in Surgical Outcomes Across Networks of the Highest-Rated US Hospitals

Author Affiliations
  • 1Department of Surgery, University of Michigan, Ann Arbor
  • 2Center for Healthcare Outcomes and Policy, Ann Arbor, Michigan
  • 3Surgical Innovation Editor, JAMA Surgery
JAMA Surg. Published online March 13, 2019. doi:10.1001/jamasurg.2019.0090
Key Points

Question  What is the consistency of surgical quality across hospitals that are affiliated with the 2018 US News & World Report Honor Roll hospitals?

Findings  In this population-based study of 87 hospitals and 143 174 patients, outcomes were not consistently better at Honor Roll hospitals. Within networks, the risk-adjusted rates for all outcomes varied widely across affiliated hospitals; for example, the differences in failure to rescue varied by 1.1-fold in some networks to as much as 4.9-fold in others.

Meaning  Surgical outcomes vary widely within hospital networks; networks should monitor outcomes to characterize and improve the extent to which a uniform standard of care is being delivered.

Abstract

Importance  Hospitals are rapidly consolidating into regional delivery networks. To our knowledge, whether these multihospital networks leverage their combined assets to improve quality and provide a uniform standard of care has not been explored.

Objective  To evaluate the extent to which surgical outcomes varied across hospitals within the networks of the highest-rated US hospitals.

Design, Settings, and Participants  This longitudinal analysis of 87 hospitals that participated in 1 of 16 networks that are affiliated with US News & World Report Honor Roll hospitals used data from Medicare beneficiaries who were undergoing colectomy, coronary artery bypass graft, or hip replacement between 2005 and 2014 to evaluate the variation in risk-adjusted surgical outcomes at Honor Roll and affiliated hospitals within and across networks. The data were analyzed between April 20, 2018, and June 25, 2018.

Main Outcomes and Measures  Thirty-day postoperative complications, mortality, failure to rescue, and readmissions.

Results  Of 143 174 patients, 68 718 (48.0%) were men, 124 427 (86.9%) were white, and the mean (SD) age was 71.8 (9.9) years and 73.5 (9.1) years in Honor Roll and affiliated hospitals, respectively. Outcomes were not consistently better at Honor Roll hospitals compared with network affiliates. For example, Honor Roll hospitals had lower failure to rescue rates (13.3% vs 15.1%; odds ratio, 0.92; 95% CI, 0.86-0.98) but higher complication rates (22.1% vs 18.0%; odds ratio, 1.11; 95% CI, 1.03-1.19). Within networks, risk-adjusted outcomes varied widely across affiliated hospitals. The differences in failure to rescue varied by as little as 1.1-fold (range, 12.7%–14.3%) in some networks to as much as 4.9-fold (range, 7.6%–37.3%) in others. Similarly, complication rates varied by 1.1-fold (range, 21%–23%) to 4.3-fold (range, 6%–26%) across all networks.

Conclusions and Relevance  Surgical outcomes vary widely across hospitals affiliated with the US News & World Report Honor Roll hospitals. Public reporting mechanisms should provide patients with information on the quality of all network-affiliated hospitals. Networks should monitor variations in outcomes to characterize and improve the extent to which a uniform standard of care is being delivered.

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