How to Evaluate a Surgeon and Hospital Before You Decide on the Operation

Experience matters. Whether in the boardroom, classroom or operating room, you’re in better hands when those hands have done the job many times before. When it comes to surgery, in particular, where mistakes can cost lives, recent studies show that outcomes are far better when the procedure is performed by a skilled, experienced surgeon in a hospital or ambulatory surgical center that performs a significant volume of a particular operation. Yet vital as this information is, it can be hard to come by unless you know where to look and what questions to ask.

For advice on how to evaluate a particular surgeon and institution so you can make the best decision about where to have a procedure performed and by whom, I turned to Thomas R. Russell, MD, executive director of the American College of Surgeons and author of the book, I Need an Operation… Now What? He had helpful advice on where consumers can look to learn more about surgeons and surgical procedures, as well as a useful list of questions to ask a surgeon before you schedule the operation.

EVIDENCE SHOWS IMPORTANCE OF EXPERIENCE

There is truth to the old adage that practice makes perfect, Dr. Russell observes. The more times a surgeon performs an operation, the more adept he/she becomes at doing it. He also points out that nowadays surgery is very much a team effort that relies on the contributions of many skilled professionals, from anesthesiologists to assistant surgeons to nurses, all of whom should be experienced. Your goal should be to have your operation done in an institution that performs it regularly, not just once or twice a year — and with good outcomes no matter how complicated or “simple” your procedure is.

If you are going to an academic hospital, remember that teaching hospitals operate differently. Be aware that each July, a new group of first-year physicians-in-training arrive at teaching hospitals. These young doctors are guided by senior surgeons, so they are not flying solo — but it’s fair to express concern about being in inexperienced hands, by saying something along these lines to the more experienced doctor: “I have some concerns about being treated by the surgical resident, and I want to make sure that if one is involved, you will have oversight and will supervise closely.”

FINDING THE DATA

The problem is, there is no single authoritative database where you can look up a particular procedure to find a formula of how many operations a surgeon has to have done, in a hospital that has how many of them each year, in order to predict a successful outcome. In this new age of transparency, however, a number of government agencies, academic institutions and medical facilities are working to fill this gap with evidence-based studies and numbers that help consumers figure out this information.

Not surprisingly, research overwhelmingly shows the importance of experience on the parts of both the surgeon and the institution. For example…

  • Researchers at Memorial Sloan-Kettering Cancer Center in New York City found that a prostate cancer patient’s chance of recurrence depends on his surgeon’s level of experience. Surgeons who have performed 250 radical prostatectomies have a higher cure rate.
  • To increase the odds your colonoscopy will be performed with technical competency, seek a doctor who has done more than 150 of them, according to researchers at Soon Chun Hyang University in South Korea.
  • At hospitals where a high volume of a particularly complicated pancreatic surgery, called a Whipple procedure, is performed by only a small number of experienced surgeons, the mortality rate from the operation is less than 4%, according to the University of Southern California. Elsewhere, death rates may be as high as 15% to 20%.
  • The Agency for Healthcare Research and Quality (http://www.ahrq.gov/) provides the following list specifying the number of particular procedures you’d want to know are done in a hospital each year before deciding to have one of these operations done there…
  • Esophageal cancer surgery: 7
  • Pancreatic cancer surgery: 7
  • Abdominal aortic aneurysm repair: 32
  • Carotid endarterectomy: 101
  • Coronary artery bypass graft surgery: 500
  • Percutaneous coronary angioplasty: 400

ASK THE RIGHT QUESTIONS

When meeting with a surgeon, remember that it’s all about what’s best for you. Frame the appointment in your mind as an interview, taking the opportunity to sit with your potential surgeon and speak openly and frankly about all your treatment options, and how much experience he/she has had with each of them. Dr. Russell recommends that you ask the following questions:

  • How many of these procedures have you performed in your career?
  • How many of these operations have you done in the last year?
  • What range of outcomes have you experienced with this procedure, with approximately what frequencies?
  • How many of these procedures are done at this hospital each year?
  • What is the history of complications from this surgery at this institution? What is the death rate? What is the rate of resulting impairment? Have you been involved in litigation around this procedure?

If a doctor is unwilling or unable to discuss these questions, provides unsatisfactory answers or is impatient with you for asking them, it’s not unreasonable to seek another opinion.

DO YOUR HOMEWORK

Patients today need to educate themselves about their health-care choices, stresses Dr. Russell. In addition to asking doctors questions, there are many reputable internet Web sites where you can learn a great deal about treatment options and the surgeons and hospitals offering them. These include sites associated with the government, such as MedlinePlus, http://www.nlm.nih.gov/medlineplus/ and the National Cancer Institute, www.cancer.gov/… organizations like the American Cancer Society, http://www.cancer.org/ and the Arthritis Foundation, http://www.arthritis.org/… and academic institutions including Mayo Clinic, http://www.mayoclinic.com/ and Cleveland Clinic, http://www.clevelandclinic.org/.

Useful Web sites for comparing the records of doctors and hospitals in their performance of various procedures include Hospital Compare (www.hospitalcompare.hhs.gov) and The Leapfrog Group (www.leapfroggroup.org). Castle Connolly Medical publishes America’s Top Doctors directory (www.castleconnolly.com) — and of course, that’s a good place to find your surgeon’s name listed. You can confirm the specialty certification of your doctor at the American Board of Medical Specialties at www.abms.org, and check to see if a health care organization is accredited by The Joint Commission at www.qualitycheck.org. The American Medical Association’s doctor finder at apps.ama-assn.org/doctorfinder/ will help you find licensed physicians and their credentials, education, etc.

Admittedly, getting all these answers before a surgical procedure requires some effort. But it behooves you to choose your surgeon with care, since your life is, quite literally, in his/her hands — and therefore it’s worth the extra time it takes to ensure that those hands are as experienced as they need to be.