Finding the Right Surgeon - Part I

Anyone undergoing a surgical procedure wants nothing more than to come out of the operating room with minimal pain, rapid healing, no complications, and their health problem solved. Unfortunately, elective surgery sometimes becomes something that patients regret. According to ProPublica, at least 200,000 Americans die each year because of preventable medical errors in hospitals, making it the third leading cause of death in the United States, with six times as many deaths as from auto accidents. 

When choosing the surgeon that is right for you, many factors should be taken into account. Does the surgeon have experience with patients in your age group or with patients having underlying medical conditions similar to yours? For example, an orthopedic specialist with a record of performing successful athletic injury surgeries on younger patients may not be the best choice for an 80-year old patient needing back surgery. Take into consideration the doctor's level of attention at your initial visits, which can be an indication of the kind of care you will receive after the surgery is completed, the responsiveness of the office staff, and the reputation of the hospital where the procedure will be performed.

In addition to these factors, there are online resources that can help you decide. Check out some doctor ratings sites that have patient-provided ratings and reviews. (See our article on doctor ratings for some examples.) In addition to those, there are at least two sites that focus specifically on surgeon ratings:  Surgeonratings.org and SurgeonScorecard.org.   

Ratings of Surgeons Performing 12 High-Risk Surgeries: SurgeonRatings.org
Surgeonratings.org is published by the Center for Study of Services, also known as Consumers Checkbook.  Unlike their main database of service provider ratings, no membership or password is required to access the surgeon information. Note: as of February 2023, the site is not available but says that it will be re-launched soon.

The site provides ratings of individual surgeons for twelve high-risk surgeries based on how many patients had complications after the surgery. Surgeons are rated on a five-star scale based on the level of confidence that the surgeon's outcomes are better-than-average or worse-than-average for post-surgery complications.  The data is based on analysis of Medicare records for more than 5 million surgeries performed by more than 50,000 surgeons nationwide.  Rates of deaths, length of hospital stay (prolonged length of stay indicates likely complications), hospital readmissions within 90 days of surgery are all considered, after risk-adjustments for patient characteristics, to determine the surgeon ratings.

The chart below lists the twelve surgeries covered in the database, along with the best, average, and worst complication rates. The types of surgeries included are: hip/knee replacement; prostatectomy/cystectomy/nephrectomy; carotid endarterectomy/agioplasty; spinal cord exploration/spinal cord fusion; gastric/bariatric (obesity); gallbladder removal; lung surgery; femur fracture repair; antioplasty/pacemaker; heart valve /heart bypass surgery; major bowel surgery; aortic/lower extremity vascular surgery.

The site provides individual surgeon's ratings. Ideally, find a doctor with a low or average complication rate. Keep in mind that the complication rates may seem high for even the five-star doctors. These are riskier procedures, and the data is based on surgeries performed in hospitals on older or disabled patients (covered by Medicare), and cover complications over a 90-day time span.

SurgeonRatings.org also provides information on surgeons that are most often recognized by their peers. They send surveys to all actively practicing physicians in the 53 largest metropolitan areas in the U.S. and ask them for the name of one or two doctors in each of 38 specialty fields they "would consider most desirable for care of a loved one."

Visit the site again later this year, as Checkbook plans to update the data. Currently, the data is based on surgeries only going through 2015.

Ratings of Surgeons Performing 8 Surgeries: ProPublica's Surgeon Scorecard

Like Checkbook's "Surgeon Ratings" database, Propublica's "Surgeon Scorecard" database provides information on complication rates for common surgeries based on Medicare claims data, but it has not been updated recently and covers the years 2009 - 2014.

The eight elective procedures covered by Surgeon Scorecard:

1. knee replacement

2. hip replacement

3. spinal fusion, neck (cervical)

4. spinal fusion, lumbar (lower back, anterior)

5. spinal fusion, lumbar (lower back, posterior)

6. gall bladder removal, laparoscopic (minimally invasive)

7. prostate removal

8. prostate resection

A surgeon is only included in the database if he or she has performed the procedure at least 20 times. More than 16,000 surgeons' complication rates as defined by Propublica are included. If a patient was readmitted to any hospital or died within 30 days of a surgery, it was counted as a complication. In the Checkbook database, the timeline is 90 days, so you will find that the average complication rates are lower in Propublica's database. The total number of surgeries is 2.3 million in the Propublica database compared with 5 million in Checkbook's database.

The "Find a Hospital" feature gives rates of complications information for the surgeries at the hospital-level, along with the surgeons who performed that surgery at the hospital. You can also view an easy-to-understand table of all the hospitals by state, with a graphic representation of the rates of complications for each kind of surgery.

At this time, there are no announcements on the Propublica web site that the database will be updated any time soon, so the information is becoming out-of-date.

Propublica's database has received much criticism, partly because it only includes Medicare claims data and not procedures covered by private insurance. Nevertheless, it is a tool providing objective data that can be evaluated in perspective.

A prostate cancer patient wrote about Surgeon Scorecard on the Cancer Survivors Network:

"I did not use this site to find a particular surgeon, but to make sure anyone involved in my operation did not have a poor and consistent record of complications. I think that is the intended use of this website. I know you can't really rely on word of mouth from personnel associated with any hospital or surgeon, because they always use glowing terms in every instance. But this site, if what they say is true, will give you the hard facts if any particular surgeon or hospital lags far behind their peers."

For more information on researching surgeries, hospitals, and surgeons read Part II of this article: "Finding the Right Surgeon Part II"

Check out our article, "Comparing Popular Doctor Ratings Sites" for descriptions and pros and cons of sites where patients rate their experiences with doctors.