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Original Investigation
Pacific Coast Surgical Association
July 31, 2019

Association of US News and World Report Top Ranking for Gastroenterology and Gastrointestinal Operation With Patient Outcomes in Abdominal Procedures

Author Affiliations
  • 1Department of Surgery, University of California Irvine Medical Center, Orange, California
JAMA Surg. Published online July 31, 2019. doi:10.1001/jamasurg.2019.2327
Key Points

Question  Are the hospitals included in the US News and World Report annual rankings of the best in gastroenterology and gastrointestinal surgical procedures associated with improvements in patient outcomes in common advanced laparoscopic abdominal operation compared with nonranked hospitals?

Findings  In this administrative database study of 51 869 abdominal operations, the annual case volume was 397 at top-ranked hospitals compared with 114 at nonranked hospitals. No statistically significant differences in serious morbidity or in-hospital mortality were found between these cohorts.

Meaning  Within the context of academic centers, top-ranked hospitals performed a higher number of laparoscopic abdominal operations, but improved patient outcomes after these procedures did not appear to be associated with hospital ranking.


Importance  The US News & World Report (USNWR) annual ranking of the best hospitals for gastroenterology and gastrointestinal operations provides guidance and referral of care for medical and surgical gastrointestinal conditions.

Objective  To investigate whether USNWR top-ranked hospitals for gastroenterology and gastrointestinal surgical procedures are associated with improvements in patient outcomes, compared with nonranked hospitals, in common advanced laparoscopic abdominal operations.

Design, Setting, and Participants  This study used the Vizient database, which contains administrative, clinical, and financial inpatient information of index hospitalizations for US academic centers and their affiliated hospitals that are members of Vizient. Data were obtained on advanced laparoscopic abdominal operations performed from January 1, 2017, through December 31, 2017, at USNWR top-ranked hospitals (n = 16 296 operations) and nonranked hospitals (n = 35 573 operations). Abdominal operations included bariatric, colorectal, and hiatal hernia procedures. Operations on patients younger than 18 years, emergent cases, conversion cases, and patients with extreme severity of illness were excluded.

Main Outcomes and Measures  Outcome measures included in-hospital mortality, mortality index (observed to expected mortality ratio), serious morbidity, length of stay, and cost.

Results  A total of 51 869 advanced laparoscopic abdominal operations were performed at 351 academic health centers and their community affiliates. Of these procedures, 16 296 (31.4%) were performed at 41 top-ranked hospitals and 35 573 (68.6%) at 310 nonranked hospitals. The annual case volume at top-ranked hospitals was 397 compared with 114 at nonranked hospitals. Between top-ranked and nonranked hospitals, no significant differences were found in in-hospital mortality (0.04% vs 0.07%; P = .33) or serious morbidity (1.06% vs 1.02%; P = .75). Compared with nonranked hospitals, advanced laparoscopic abdominal operations performed at top-ranked hospitals had higher mean costs ($7128 [$4917] vs $7742 [$6787]; P < .01) and longer mean lengths of stay (2.38 [2.60] days vs 2.73 [3.31] days; P < .01).

Conclusions and Relevance  Although, among academic centers, the annual volume of advanced laparoscopic abdominal operations was 3-fold higher for USNWR top-ranked hospitals compared with nonranked hospitals, the volume did not appear to be associated with improved patient outcomes.

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