title: Use of Unsolicited Patient Observations to Identify Surgeons With Increased Risk for Postoperative Complications.
abstract: Unsolicited patient observations are associated with risk of medical malpractice claims. Because lawsuits may be triggered by an unexpected adverse outcome superimposed on a strained patient-physician relationship, a question remains as to whether behaviors that generate patient dissatisfaction might also contribute to the genesis of adverse outcomes themselves.
  
  
  
  To examine whether patients of surgeons with a history of higher numbers of unsolicited patient observations are at greater risk for postoperative complications than patients whose surgeons generate fewer such unsolicited patient observations.
  
  
  
  This retrospective cohort study used data from 7 academic medical centers participating in the National Surgical Quality Improvement Program and the Vanderbilt Patient Advocacy Reporting System from January 1, 2011, to December 31, 2013. Patients older than 18 years included in the National Surgical Quality Improvement Program who underwent inpatient or outpatient operations at 1 of the participating sites during the study period were included. Patients were excluded if the attending surgeon had less than 24 months of data in the Vanderbilt Patient Advocacy Reporting System preceding the date of the operation. Data analysis was conducted from June 1, 2015, to October 20, 2016.
  
  
  
  Unsolicited patient observations for the patient's surgeon in the 24 months preceding the date of the operation.
  
  
  
  Postoperative surgical or medical complications as defined by the National Surgical Quality Improvement Program within 30 days of the operation of interest.
  
  
  
  Among the 32 125 patients in the cohort (13 230 men, 18 895 women; mean [SD] age, 55.8 [15.8] years), 3501 (10.9%) experienced a complication, including 1754 (5.5%) surgical and 2422 (7.5%) medical complications. Prior unsolicited patient observations for a surgeon were significantly associated with the risk of a patient having any complication (odds ratio, 1.0063; 95% CI, 1.0004-1.0123; P = .03), any surgical complication (odds ratio, 1.0104; 95% CI, 1.0022-1.0186; P = .01), any medical complication (odds ratio, 1.0079; 95% CI, 1.0009-1.0148; P = .03), and being readmitted (odds ratio, 1.0088, 95% CI, 1.0024-1.0151; P = .007). The adjusted rate of complications was 13.9% higher for patients whose surgeon was in the highest quartile of unsolicited patient observations compared with patients whose surgeon was in the lowest quartile.
  
  
  
  Patients whose surgeons have large numbers of unsolicited patient observations in the 24 months prior to the patient's operation are at increased risk of surgical and medical complications. Efforts to promote patient safety and address risk of malpractice claims should continue to focus on surgeons' ability to communicate respectfully and effectively with patients and other medical professionals.
authors.affiliation: Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: William O
authors.initials: WO
authors.lastname: Cooper
authors.affiliation: Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Oscar
authors.initials: O
authors.lastname: Guillamondegui
authors.affiliation: Division of General Surgery, University of California, Los Angeles Medical Center.
authors.forename: O Joe
authors.initials: OJ
authors.lastname: Hines
authors.affiliation: Department of Surgery, University of North Carolina, Chapel Hill.
authors.forename: C Scott
authors.initials: CS
authors.lastname: Hultman
authors.affiliation: Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
authors.forename: Rachel R
authors.initials: RR
authors.lastname: Kelz
authors.affiliation: Department of Surgery, Wake Forest University, Winston-Salem, North Carolina.
authors.forename: Perry
authors.initials: P
authors.lastname: Shen
authors.affiliation: Department of Surgery, Stanford University, Stanford, California.
authors.forename: David A
authors.initials: DA
authors.lastname: Spain
authors.affiliation: Department of Internal Medicine, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: John F
authors.initials: JF
authors.lastname: Sweeney
authors.affiliation: Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Ilene N
authors.initials: IN
authors.lastname: Moore
authors.affiliation: Department of Medicine, Stanford University, Stanford, California.
authors.forename: Joseph
authors.initials: J
authors.lastname: Hopkins
authors.affiliation: Department of Internal Medicine, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Ira R
authors.initials: IR
authors.lastname: Horowitz
authors.affiliation: Department of Surgery, Wake Forest University, Winston-Salem, North Carolina.
authors.forename: Russell M
authors.initials: RM
authors.lastname: Howerton
authors.affiliation: Department of Surgery, Wake Forest University, Winston-Salem, North Carolina.
authors.forename: J Wayne
authors.initials: JW
authors.lastname: Meredith
authors.affiliation: Department of Internal Medicine, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Nathan O
authors.initials: NO
authors.lastname: Spell
authors.affiliation: Department of Quality and Patient Safety, University of Pennsylvania Health System, Philadelphia.
authors.forename: Patricia
authors.initials: P
authors.lastname: Sullivan
authors.affiliation: Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Henry J
authors.initials: HJ
authors.lastname: Domenico
authors.affiliation: Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: James W
authors.initials: JW
authors.lastname: Pichert
authors.affiliation: Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Catron
authors.affiliation: Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Lynn E
authors.initials: LE
authors.lastname: Webb
authors.affiliation: Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee2Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Roger R
authors.initials: RR
authors.lastname: Dmochowski
authors.affiliation: Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Jan
authors.initials: J
authors.lastname: Karrass
authors.affiliation: Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee12Center for Quality, Safety and Risk Prevention, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Gerald B
authors.initials: GB
authors.lastname: Hickson
mesh_terms: D015331:Cohort Studies; D003142:Communication; D003144:Communication Barriers; D003430:Cross-Sectional Studies; D006801:Humans; D033183:Interdisciplinary Communication; D000070516:Intersectoral Collaboration; D008318:Malpractice / Q000706:statistics & numerical data; D010353:Patient Education as Topic; D061214:Patient Safety; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D011183:Postoperative Complications / Q000175:diagnosis* / Q000453:epidemiology*; D011785:Quality Assurance, Health Care; D058996:Quality Improvement / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012306:Risk; D013223:Statistics as Topic; D066231:Surgeons / Q000706:statistics & numerical data*; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data