Rankings versus reality in pancreatic cancer surgery: a real-world comparison.
BACKGROUND
Patients are increasingly confronted with systems for rating hospitals. However, the correlations between publicized ratings and actual outcomes after pancreatectomy are unknown.


METHODS
The Massachusetts Division of Health Care Finance and Policy Hospital Inpatient Discharge Database was queried to identify pancreatic cancer resections carried out during 2005-2009. Hospitals performing fewer than 10 pancreatic resections in the 5-year period were excluded. Primary outcomes included mortality, complications, median length of stay (LoS) and a composite outcomes score (COS) combining primary outcomes. Ranks were determined and compared for: (i) volume, and (ii) ratings identified from consumer-directed hospital ratings including the US News & World Report (USN), Consumer Reports, Healthgrades and Hospital Compare. An inter-rater reliability analysis was performed and correlation coefficients (r) between outcomes and ratings, and between rating systems were calculated.


RESULTS
Eleven hospitals in which a total of 804 pancreatectomies were conducted were identified. Surgical volume correlated with overall outcome, but was not the strongest indicator. The highest correlation referred to that between USN rank and overall outcome. Mortality was most strongly correlated with Healthgrades ratings (r = 0.50); however, Healthgrades ratings demonstrated poorer correlations with all other outcomes. Consumer Reports ratings showed inverse correlations.


CONCLUSIONS
The plethora of publicly available hospital ratings systems demonstrates heterogeneity. Volume remains a good but imperfect indicator of surgical outcomes. Further systematic investigation into which measures predict quality outcomes in pancreatic cancer surgery will benefit both patients and providers.
Surgical Outcomes Analysis and Research (SOAR), University of Massachusetts Medical School, Worcester, MA, USA.
Zeling
Z
Chau
James K
JK
West
Zheng
Z
Zhou
Theodore
T
McDade
Jillian K
JK
Smith
Sing-Chau
SC
Ng
Tara S
TS
Kent
Mark P
MP
Callery
A James
AJ
Moser
Jennifer F
JF
Tseng
D003661:Decision Support Techniques; D061847:Hospitals, High-Volume / Q000592:standards*; D006801:Humans; D007902:Length of Stay; D008404:Massachusetts; D010043:Outcome and Process Assessment, Health Care / Q000592:standards*; D010180:Pancreatectomy / Q000009:adverse effects / Q000401:mortality / Q000592:standards*; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications / Q000401:mortality / Q000628:therapy; D019984:Quality Indicators, Health Care / Q000592:standards*; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome