Like anyone else, doctors and nurses tend to get better with practice. So when picking a hospital for a particular kind of surgery, a standard rule of thumb is to find a facility that does lots of them.
A new state report allows Pennsylvania consumers to do just that for four common operations: hip and knee replacements, heart bypass surgery, and spinal fusion. Results for hospitals in Bucks, Chester, Delaware, and Montgomery Counties and Philadelphia are shown in tables below.
The data from the Pennsylvania Health Care Cost Containment Council also include the rate of complications after each surgery. For the three orthopedic procedures, that means the percent of patients who develop an infection, bleeding, or loosening of the joint, among other issues. For bypass surgery, the key indicators are what percent of patients die in the hospital and how many need to be readmitted within 30 days of being discharged.
With each surgery, the agency determined whether these rates were lower (better) than expected, as good as expected, or higher (worse) than expected. The calculations were risk-adjusted, meaning the hospitals were graded on a curve based on a variety of health and demographic indicators for their patients: age, socioeconomic status, and how sick they were upon admission.
For example, Penn Presbyterian Medical Center and Bryn Mawr Hospital reported similar rates of complications following knee replacements, both slightly under 1%.
But Penn Presbyterian’s rate, 0.9%, was deemed to be better than expected, while Bryn Mawr’s rate, 0.8%, was judged to fall within the expected range. That suggests Penn Presbyterian’s patients were older, sicker, or poorer than Bryn Mawr’s, on average.
Socioeconomic status plays a role not just in how well patients fare after surgery, but in whether they even undergo the operation.
People living in high-poverty areas were about one-third less likely to get hip and knee replacements, compared with the broader population. The statewide rate of knee replacements was 36.7 procedures per 10,000 people, but only 25.3 per 10,000 in high-poverty areas.
For hip replacements, the statewide rate was 22.5 per 10,000 people, but just 15.3 per 10,000 in high-poverty areas.
The data on the three orthopedic surgeries cover the period from July 2017 through June 2018. Heart bypass surgeries were reported for April 2016 through June 2018, not including those that involved a valve procedure.
All hospitals with higher-than-expected complication rates said they had taken steps to improve since the end of the reporting period in mid-2018. At Temple, for example, all patients are counseled to bathe for several days in advance of joint surgery with antimicrobial soap, and the hospital said it has seen no infections after hip or knee replacements in more than a year.
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