The survival rate for high-risk surgeries continues to vary in hospitals across the country, with only two hospitals in Michigan fully meeting national standards for all procedures examined.
The Leapfrog Group, a national nonprofit watchdog organization, released its “Predicting Patient Survival of High-Risk Surgeries” report March 12, which indicated Spectrum Health Butterworth Hospital in Grand Rapids was one of 37 hospitals across the country meeting its standards for survival rates for four high-risk surgical procedures.
The report is the second in a series prepared by Castlight Health based on the 2014 Leapfrog Hospital Survey, which assesses measures such as quality, efficiency and safety practices of hospitals across the country to provide a benchmarking tool and assist consumers and purchasers in making informed decisions.
The report indicated the predicted survival rates for the high-risk surgeries continue to vary significantly, with a 19 percentage point variance for pancreatectomy and a 13 percentage point difference from the best-performing and worst-performing hospitals for abdominal aortic aneurysm repair. The two other high-risk surgical procedures were aortic valve replacement with a survival rate ranging from 92 percent to 97 percent, and esophagectomies with a variance of 88 percent to 98 percent.
Of the hospitals surveyed, only 17 percent fully met Leapfrog’s safety standards for aortic valve replacements, roughly 30 percent met standards for esophagectomies and abdominal aortic aneurysm repair, and roughly 42 percent met outcomes for pancreatectomies.
Bret Jackson, president of Economic Alliance for Michigan, said the study indicated if patients aren’t having high-risk surgeries done at a hospital that meets high-quality standards, there is a serious risk of death.
“The issue here is mortality: how many people live or die based on (hospitals’) ability to treat patients appropriately for whatever conditions they are presented with,” said Jackson. “These are very high-risk conditions, and some of them are quite rare, too.”
The Economic Alliance for Michigan serves as Leapfrog’s coordinator, working with hospitals in the state to participate in the annual survey, recognizing organizations that deliver quality care, and driving public knowledge, according to Jackson.
Spectrum Health Butterworth Hospital and University of Michigan Health System in Ann Arbor were the two hospitals in Michigan fully meeting Leapfrog’s survival rate standards for all four surgeries. Jackson said it is reflective of the organizations’ commitments to quality.
“This is a life or death issue,” said Jackson. “Spectrum and the University of Michigan, as well as about two dozen other hospitals in Michigan, are doing very well in delivering good quality to the patients, and that translates to not only saving lives and quality of stay when you are in a hospital, but also means purchasers are saving money by having patients in hospitals delivering high quality.”
Spectrum Health Butterworth reported a volume of 320 aortic valve replacements in 2014, which exceeds Leapfrog’s standard number of annual procedures. Based on the risk-adjusted average mortality rate, the hospital has a better than average outcome rank. In terms of AAA repair, Spectrum conducted roughly 127 procedures and had a predicted survival rate of 98.8 percent, which exceeds the standard 97.3 percent survival rate.
Leapfrog’s standard for pancreatectomy is a 91.3 percent predicted survival rate, and Butterworth had a 97.3 percent predicted rate for 55 surgical procedures in 2014, according to Leapfrog’s hospital ratings. For approximately 29 esophagectomies, there was a 94.2 percent predicted survival rate at Butterworth, which exceeded the standard 91.7 percent rate for patients undergoing the procedure.
Dr. Carlos Rodriguez, department chief of surgical specialties at Spectrum Health, said the surgical aspect of the entire process is an important part of delivering quality care, but quality begins when the patient is referred to the surgeon.
“Preoperative evaluation, the risk adjustment we have to do, the preparation of the patient … those are things helping us with the success of the operation. We leave no stone unturned to make sure everything goes well,” said Rodriguez. “It doesn’t matter if it is something as simple as a breast biopsy or something as complicated as a big trauma; we go through the same steps every time to make sure we don’t miss anything.”
One of the changes made in the past few years includes receiving a preoperative history and physical in addition to an order by the referring physician three days prior to the operation to allow adequate preparation, according to Rodriguez. Other steps included in the process include a debriefing at the end of the case and interdisciplinary team rounding on patients in the intensive care unit who are high risk.
“We actually recently looked at our pancreatectomy data and our esophagectomy data, and we fare very favorably not just on Leapfrog, but on some of the national standards comparing ourselves to Cleveland Clinic and Mayo Clinic,” said Rodriguez. “I think it is a really good program. We have an excellent infrastructure to do these cases that are difficult.”
Dr. J. Michael Kramer, senior vice president and chief quality officer at Spectrum Health, said the organization is grateful for the level of discussion taking place across the country about safety and attributes the care outcome to the surrounding culture.
“We value the transparency and ability to learn and improve the risk patients might have in front of them. We would like to think it’s because of our excellent surgeons, but I think it’s the surrounding of a whole program of interdisciplinary teams and a culture that emphasizes safety and a willingness to put it above all other concerns,” said Kramer.
“We participate in more than 40 different national registries, and every one of our clinical programs is looking at data, comparing to national standards, and trying to exceed national standards.”