WHEN SHOPPING FOR SURGEONS, health care consumers often choose the most experienced doctor they can find. But a new research paper co-authored by Amitabh Chandra, the Malcolm Wiener Professor of Social Policy at Harvard Kennedy School (HKS), finds that a surgeon’s degree of specialization may be a better indicator of quality in the operating room than the overall number of surgeries he or she has performed.
“Surgeon specialization and operative mortality in United States: retrospective analysis” is published in the July 23 edition of BMJ (formerly the British Medical Journal).
To test their theory, Chandra and co-authors Nikhil R. Sahni, Maurice Dalton, David M. Cutler, and John D. Birkmeyer examined Medicare data on almost 700,000 cardiovascular and cancer operations performed in the U.S. by more than 25,000 surgeons between 2008 and 2013. They measured 30-day patient mortality rates between surgeons who performed the same number of procedures, but differed in the degree of specialization, defined by the number of times the specific procedure was performed as compared to a surgeon’s total operative volume.
“For all four cardiovascular procedures and two out of four cancer resections, a surgeon’s degree of specialization was a significant predictor of operative mortality independent of the number of times he or she performed that procedure,” the authors write. “Furthermore, for five procedures, the relative risk reduction in mortality from selecting a surgeon in the top quarter of surgeon specialization was greater than that from selecting a surgeon in the top quarter of procedure specific volume. Additionally, surgeon specialization accounted for at least some portion (if not all) of the observed volume-outcomes relation.”
The authors argue that this study may have important implications for health care consumers, doctors, administrators and policy makers. “The observed specialization-outcomes relation suggests a new, easily measured metric of surgeons’ quality,” they write.
“Policy makers considering how to improve the quality of rural or smaller hospitals in which surgeons cannot meet minimal volume thresholds could use surgeon specialization to assign patients to surgeons. At larger facilities, administrators determining case distribution across surgeons might consider not only a given surgeon’s volume in that procedure but also his or her degree of specialization,” the authors suggest. “A physician might use a measure of surgeon specialization to refer his or her patient to the most appropriate surgeon, possibly improving patients’ outcomes. Finally, if these data are made available to a patient, he or she could choose a surgeon who specializes in the relevant procedure to possibly improve his or her chance of survival.”