CONSUMER REPORTS INSIGHTS

Consumer Reports suggests smart ways to choose a surgeon

(Michael Sloan)
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Tuesday, April 27, 2010

Even relatively straightforward procedures such as gallbladder removal or hernia repair can sometimes cause serious complications, so you always want to be in good surgical hands. But the surgeon and hospital staff can be especially important for procedures that are new or unusually complex or that are being done to treat a potentially fatal disease such as cancer. Here are some tips on finding the surgeon and hospital that are best for your situation.

Signs of excellence

One indicator is how often surgeons and hospitals perform a procedure. That can be vital for operations that are relatively new, such as gastric bypass surgery for treating obesity. While many surgeons have started performing the operation, not all are equally qualified. A September 2009 study found that the risk of serious complications from the most common form of gastric bypass surgery fell by 10 percent for every additional 10 cases per year the surgeon had performed.

Volume may also be especially important for unusually complicated procedures. For example, a study by researchers at New Hampshire's Dartmouth-Hitchcock Medical Center of people undergoing surgery for pancreatic cancer found that annual death rates were nearly four times higher for those treated by surgeons who performed the fewest operations than for those who performed this demanding procedure most often.

But quantity isn't the only or even most important measure of quality. A May 2009 study of 81,289 adults who had coronary-artery bypass surgery, for example, found that success depended more on how well surgeons and hospitals adhered to various markers of surgical excellence, such as using the appropriate technique during the operation and prescribing the right medications before and afterward, than the number of procedures they performed.

And a study of more than 10,700 prostate-cancer operations found that complication rates varied considerably even among those that were performed by high-volume surgeons. The authors concluded that experienced surgeons and hospitals still need to monitor their success and complication rates better and work to improve their techniques and safety measures.

Question your surgeon

Ask your prospective surgeon these questions before going under the knife:

-- Is surgery necessary? The best way to avoid surgical errors is to avoid surgery entirely, so ask about the effectiveness and safety of alternatives. Compare those with the risks of surgery and the chance that it will help you.

-- Is your board certification up-to-date? Look for a surgeon who has undergone the necessary training, even after being in clinical practice, to maintain board certification in his or her specialty. To check on a doctor's certification status, contact the American Board of Medical Specialties by calling 866-ASK-ABMS or going to http://www.abms.org.

-- What's your experience? Ask how many operations the surgeon has performed in the past year and how that compares with his or her peers. "It's not that you have to find the busiest, most experienced surgeon in North America," says Andrew Auerbach, an associate professor of medicine at the University of California at San Francisco and an expert in surgical outcomes. "It's more about avoiding the guy who does very few of the procedures, especially in a place that does very few."

-- What are your success, failure and complication rates? Not all will be able or willing to tell you, but the good ones should be.

-- What's the hospital's infection rate? Seventeen states now make that information public, and many hospitals report their rates voluntarily. For information on how to find those data, and more on hospital infections, go to http://www.consumerreportshealth.org and click on the "Doctors and Hospitals" tab. You can also find additional information there on how to compare hospitals.

-- Does the hospital follow best practices? The federal Centers for Medicare and Medicaid Services tracks how frequently hospitals give antibiotics on schedule, control blood sugar in heart-surgery patients, prepare skin properly before incisions and take other steps proven to help prevent surgical complications. For details, go to http://www.hospitalcompare.hhs.gov and click on "Find and Compare Hospitals."

Copyright 2010. Consumers Union of United States Inc.

For further guidance, go to ConsumerReportsHealth.org. More-detailed information -- including CR's ratings of prescription drugs, conditions, treatments, doctors, hospitals and healthy-living products -- is available to subscribers to that site.


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