Key Points
Question
Are the hospitals included in the US News & World Report annual rankings of the best in gastroenterology and gastrointestinal surgical procedures associated with improvements in patient outcomes in common advanced laparoscopic abdominal operation compared with nonranked hospitals?
Findings
In this administrative database study of 51 869 abdominal operations, the annual case volume was 397 at top-ranked hospitals compared with 114 at nonranked hospitals. No statistically significant differences in serious morbidity or in-hospital mortality were found between these cohorts.
Meaning
Within the context of academic centers, top-ranked hospitals performed a higher number of laparoscopic abdominal operations, but improved patient outcomes after these procedures did not appear to be associated with hospital ranking.
This study examines 1 year of administrative, clinical, and financial data from US hospitals ranked in the top 50 for gastroenterology and gastrointestinal surgical procedures by US News & World Report and compares their abdominal operations outcomes with those of hospitals not included on the list.
Abstract
Importance
The US News & World Report (USNWR) annual ranking of the best hospitals for gastroenterology and gastrointestinal operations provides guidance and referral of care for medical and surgical gastrointestinal conditions.
Objective
To investigate whether USNWR top-ranked hospitals for gastroenterology and gastrointestinal surgical procedures are associated with improvements in patient outcomes, compared with nonranked hospitals, in common advanced laparoscopic abdominal operations.
Design, Setting, and Participants
This study used the Vizient database, which contains administrative, clinical, and financial inpatient information of index hospitalizations for US academic centers and their affiliated hospitals that are members of Vizient. Data were obtained on advanced laparoscopic abdominal operations performed from January 1, 2017, through December 31, 2017, at USNWR top-ranked hospitals (n = 16 296 operations) and nonranked hospitals (n = 35 573 operations). Abdominal operations included bariatric, colorectal, and hiatal hernia procedures. Operations on patients younger than 18 years, emergent cases, conversion cases, and patients with extreme severity of illness were excluded.
Main Outcomes and Measures
Outcome measures included in-hospital mortality, mortality index (observed to expected mortality ratio), serious morbidity, length of stay, and cost.
Results
A total of 51 869 advanced laparoscopic abdominal operations were performed at 351 academic health centers and their community affiliates. Of these procedures, 16 296 (31.4%) were performed at 41 top-ranked hospitals and 35 573 (68.6%) at 310 nonranked hospitals. The annual case volume at top-ranked hospitals was 397 compared with 114 at nonranked hospitals. Between top-ranked and nonranked hospitals, no significant differences were found in in-hospital mortality (0.04% vs 0.07%; P = .33) or serious morbidity (1.06% vs 1.02%; P = .75). Compared with nonranked hospitals, advanced laparoscopic abdominal operations performed at top-ranked hospitals had higher mean costs ($7128 [$4917] vs $7742 [$6787]; P < .01) and longer mean lengths of stay (2.38 [2.60] days vs 2.73 [3.31] days; P < .01).
Conclusions and Relevance
Although, among academic centers, the annual volume of advanced laparoscopic abdominal operations was 3-fold higher for USNWR top-ranked hospitals compared with nonranked hospitals, the volume did not appear to be associated with improved patient outcomes.
Introduction
Each year, US News & World Report (USNWR) rates and publishes a list of the top 50 US hospitals in 16 specialties. Ranking in 12 of 16 specialties is partly based on hard data, whereas ranking in 4 of 16 specialties (psychiatry, ophthalmology, rehabilitation, and rheumatology) is based on reputation. For the 12 specialties, hospitals that meet the minimum annual discharge-volume requirements are eligible for data ranking. The USNWR ranking methodology for gastroenterology and gastrointestinal surgical procedures is found in the eAppendix in the Supplement.
One of the 12 specialties scored is gastroenterology and gastrointestinal surgical procedures. This specialty is scored in 4 weighted domains: outcomes (37.5%), structure (30.0%), expert opinion (27.5%), and quality indicators (5.0%). These rankings are meant to help guide patients and referring clinicians to hospitals that provide high levels of care for medical and surgical gastrointestinal conditions.1
The popularity and widespread reporting of the USNWR rankings may be associated with increased name recognition, referral and patient volumes, and financial rewards for top-ranked hospitals.2 Several studies have reported an association between top-ranking hospitals and improved cardiovascular outcomes.3 However, to date, the value of the USNWR ranking in the assessment of surgical quality of common gastrointestinal operations is unknown. Furthermore, referrals to the USNWR top-ranked hospitals, which are often a far distance from patients, can place economic and psychological burdens on patients and their family members.
The objective of this study was to investigate whether top-ranked hospitals, compared with nonranked hospitals, in gastroenterology and gastrointestinal surgical procedures are associated with improvements in patient outcomes after advanced laparoscopic abdominal operations.
Methods
Data were obtained from the Vizient clinical database.4 The use of this database was approved by Vizient Inc. This study was exempted by the institutional review committee of the University of California, Irvine Medical Center as the Vizient database does not contain identifiable patient-level data. Patient informed consent was waived by this institutional review committee.
The Vizient database contains administrative, clinical, and financial inpatient information of index hospitalizations for US academic centers and their affiliated community hospitals that are members of Vizient. Criteria for this membership include any nonfederal teaching hospital or health system that (1) has a documented affiliation agreement with a medical school accredited by the Liaison Committee on Medical Education and (2) is either under common ownership with a medical school or has a reputation for excellence in service, teaching, and research, as determined at the discretion of the Vizient board of directors (composed of member organizations). Once approved for membership, academic centers are required to pay an annual fee.
This database is a collection of patient-level data of all inpatients discharged from each member academic health center and their affiliates. The data are based on billing records captured by clinical coders and include demographic, morbidity, in-hospital mortality, observed to expected (O:E) mortality ratio, and direct cost of inpatient care data. The database reports only in-hospital outcome data and not postdischarge follow-up data. Patients are risk adjusted according to severity of illness, which is classified as minor, moderate, major, or extreme. For example, a recent myocardial infarction would be classified as extreme severity.
We obtained data on elective laparoscopic bariatric, colorectal, and hiatal hernia operations performed from January 1, 2017, through December 31, 2017, at the top-ranked hospitals for gastroenterology and gastrointestinal surgical procedures. We compared these data with those from nonranked hospitals. The top 50 hospitals for gastroenterology and gastrointestinal surgical procedures included in the 2017 to 2018 USNWR ranking were cross-referenced to the academic hospitals in the Vizient database. The nonranked hospitals were defined as those in the database that were not the top ranking for gastroenterology and gastrointestinal surgical procedures.
The bariatric operation cohort included patients who underwent laparoscopic sleeve gastrectomy (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] code 4382; International Classification of Diseases and Health Related Problems, Tenth Revision, Procedure Coding System [ICD-10-PCS] code 0DB64Z3) or laparoscopic Roux-en-Y gastric bypass (ICD-9-CM code 4438; ICD-10-PCS code 0D164ZA). The colorectal operation cohort included patients who underwent laparoscopic colectomy or proctectomy (ICD-9-CM codes 1731, 1732, 1733, 1734, 1735, 1736, 1739, 4581, 4842, and 4851; ICD-10-PCS codes 0DTH4ZZ, 0DTF4ZZ, 0DTL4ZZ, 0DTG4ZZ, 0DTN4ZZ, 0DBE4ZZ, 0DTE4ZZ, and 0DTP4ZZ). The hiatal hernia operation cohort included patients who underwent laparoscopic paraesophageal hiatal hernia repair (ICD-9-CM code 5371; ICD-10-PCS codes 0BQS4ZZ and 0BQR4ZZ) or laparoscopic Nissen fundoplication (ICD-9-CM code 4467; ICD-10-PCS code 0DV44ZZ). Operations on patients younger than 18 years, emergent cases, conversion cases, and patients classified with extreme severity of illness were excluded from this study.
Demographics, including age, sex, and race/ethnicity, were queried. Race/ethnicity was self-determined by patients, and we sought it to examine discrepancies in outcomes in the current study. Primary outcome was in-hospital mortality, which represented any death before discharge. The Vizient database has no information available on death occurring after discharge, even if the death occurred within 30 days from the index operation. Secondary outcomes were O:E mortality ratio, serious morbidity, length of stay (LOS), and direct costs.
The O:E mortality ratio was defined as the observed mortality divided by the expected mortality as calculated by Vizient. The expected mortality was calculated with a risk-adjustment method of selecting a patient population to serve as the basis of the model, using multiple regression techniques to estimate the probability of mortality on the basis of normative patient population, and assigning the probability of mortality to every patient in the database. An O:E ratio less than 1 represented lower-than-expected mortality. Serious morbidity was defined as the presence of any of the following: in-hospital stroke, aspiration pneumonia, acute myocardial infarction, acute kidney injury requiring dialysis, metabolic derangement, respiratory failure, pulmonary embolism, deep vein thrombosis, active Clostridium difficile infection, postoperative infection, sepsis, shock, postoperative hemorrhage, hematoma, seroma, wound dehiscence, or readmission.
Statistical Analysis
Patient demographics were reported by hospital rank status (top-ranked vs nonranked hospitals). Categorical data were reported as percentages and compared between groups using the χ2 test with Yates correction. Continuous outcomes were reported as mean (SD) and compared between groups using unpaired, 2-tailed t test. Risk adjustments for in-hospital mortality were performed by calculating patient-level expected mortality for top-ranked vs nonranked hospitals based on Vizient’s risk model, which takes into account patient demographics and comorbidity information. In post hoc analyses, we reanalyzed the outcomes stratified by procedural type (bariatric, colorectal, and hiatal hernia operations). These post hoc analyses were exploratory in nature and were meant to generate hypotheses that might help to explain the findings of the primary end point. Statistical significance was set at a 2-sided P < .05. Missing data points were excluded from analysis. All analyses were performed using the GraphPad Prism, version 8.0 (GraphPad Inc).
Results
A total of 51 869 advanced laparoscopic abdominal operations were performed at 351 academic institutions and their affiliates during the study period. Of these procedures, 16 296 (31.4%) were performed at 41 top-ranked hospitals, and 35 573 (68.6%) were performed at 310 nonranked hospitals (Table 1). The annual volume of advanced laparoscopic abdominal operations performed at top-ranked hospitals was more than 3-fold higher than at nonranked hospitals (397 cases vs 114 cases). Within the 41 top-ranked hospitals, 11 471 (70.4%) of the patients were female, 11 027 (67.7%) were white, and 3053 (18.7%) were 65 years or older. In contrast, within the nonranked hospitals, 25 829 (72.6%) of the patients were female, 24 969 (70.2%) were white, and 4653 (13.1%) were 65 years or older.
Table 1. Characteristics of Patients Who Had Advanced Laparoscopic Abdominal Operations at Top-Ranked vs Nonranked Hospitals .
| Variable | Operations, No. (%) | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| Total | Bariatric | Colorectal | Hiatal Hernia | ||||||
| Top-Ranked Hospitals (n = 16 296) | Nonranked Hospitals (n = 35 573) | Top-Ranked Hospitals (n = 10 275) | Nonranked Hospitals (n = 25 182) | Top-Ranked Hospitals (n = 4350) | Nonranked Hospitals (n = 7936) | Top-Ranked Hospitals (n = 1671) | Nonranked Hospitals (n = 2455) | ||
| Annual case volume | 397 | 114 | 251 | 81 | 106 | 25 | 40 | 8 | |
| Sex | |||||||||
| Male | 4825 (29.6) | 9744 (27.4) | 2277 (22.2) | 5189 (20.6) | 2038 (46.9) | 3835 (48.3) | 510 (30.5) | 720 (29.3) | |
| Female | 11 471 (70.4) | 25 829 (72.6) | 7998 (77.8) | 19 993 (79.4) | 2312 (53.1) | 4101 (51.7) | 1161 (69.5) | 1735 (70.7) | |
| Race/ethnicity | |||||||||
| White | 11 027 (67.7) | 24 969 (70.2) | 6148 (59.8) | 16 575 (65.8) | 3462 (79.6) | 6337 (79.9) | 1417 (84.8) | 2057 (83.8) | |
| Nonwhite | 5269 (32.3) | 10 604 (29.8) | 4127 (40.2) | 8607 (34.2) | 888 (20.4) | 1599 (20.1) | 254 (15.2) | 398 (16.2) | |
| Age, y | |||||||||
| 18-64 | 13 243 (81.3) | 30 920 (86.9) | 9660 (94.0) | 24 832 (98.6) | 2694 (61.9) | 4702 (59.2) | 889 (53.2) | 1386 (56.5) | |
| ≥65 | 3053 (18.7) | 4653 (13.1) | 615 (6.0) | 350 (1.4) | 1656 (38.1) | 3234 (40.8) | 782 (46.8) | 1069 (43.5) | |
| Severity class | |||||||||
| Minor | 10 174 (62.4) | 24 902 (70.0) | 6770 (65.9) | 18 710 (74.3) | 2121 (48.8) | 4185 (52.7) | 1283 (76.8) | 2007 (81.8) | |
| Moderate and Major | 6122 (37.6) | 10 671 (30.0) | 3505 (34.1) | 6472 (25.7) | 2229 (51.2) | 3751 (47.3) | 388 (23.2) | 448 (18.2) | |
For the bariatric operation cohort, a total of 35 457 procedures were performed, with an annual case volume of 251 at top-ranked hospitals and 81 at nonranked hospitals. For the colorectal operation cohort, a total of 12 286 procedures were performed, with an annual case volume of 106 at top-ranked hospitals and 25 at nonranked hospitals. For the hiatal hernia operation cohort, a total of 4126 procedures were performed, with an annual case volume of 40 at top-ranked hospitals and 8 at nonranked hospitals.
Analysis of outcomes for patients who underwent advanced laparoscopic abdominal operations at top-ranked compared with nonranked hospitals is shown in Table 2. No statistically significant differences in serious morbidity (1.06% for top-ranked vs 1.02% for nonranked; P = .75) or in-hospital mortality (0.04% for top-ranked vs 0.07% nonranked; P = .33) were found between the 2 groups. The O:E mortality ratio at top-ranked was 0.28 and at nonranked was 0.56. The mean (SD) LOS was statistically significantly longer at top-ranked compared with nonranked hospitals (2.73 [3.31] days vs 2.38 [2.60] days; P < .001), whereas the mean (SD) cost was statistically significantly higher at top-ranked compared with nonranked hospitals ($7742 [$6787] vs $7128 [$4917]; P < .001).
Table 2. Outcomes of Advanced Laparoscopic Abdominal Operations at Top-Ranked vs Nonranked Hospitals .
| Outcome | All Operations, No. (%) | P Value | |
|---|---|---|---|
| Top-Ranked Hospitals (n = 16 296) | Nonranked Hospitals (n = 35 573) | ||
| In-hospital mortality | 7 (0.04) | 25 (0.07) | .33 |
| Mortality index, O:E ratio | 0.28 | 0.56 | U |
| Serious morbidity | 172 (1.06) | 363 (1.02) | .75 |
| LOS, mean (SD), d | 2.73 (3.31) | 2.38 (2.60) | <.001 |
| Direct cost, mean (SD), US$ | 7742 (6787) | 7128 (4917) | <.001 |
Abbreviations: LOS, length of stay; O:E, observed to expected; U, unable to undergo bivariate analysis.
Patient outcomes of advanced laparoscopic abdominal operations performed at top-ranked vs nonranked hospitals according to procedural type are presented in Table 3. For laparoscopic bariatric operations at top-ranked compared with nonranked hospitals, no statistically significant difference in serious morbidity (0.52% vs 0.45%; P = .48) or in-hospital mortality (0.03% vs 0.02%; P = .70) was found between the 2 groups. Patients who underwent laparoscopic bariatric operation at top-ranked hospitals, compared with nonranked hospitals, had a longer mean (SD) LOS (1.97 [2.57] days vs 1.74 [1.32] days; P < .001) and higher mean (SD) costs ($7091 [5503] vs $6531 [3646]; P < .001). For laparoscopic colorectal operations at top-ranked compared with nonranked hospitals, serious morbidity was similar (2.11% vs 2.66%; P = .07), whereas in-hospital mortality was lower at top-ranked compared with nonranked hospitals (0.05% vs 0.24%; P = .02). However, the O:E mortality ratio for patients who underwent colorectal operations was less than 1 for both top-ranked and nonranked hospitals (0.16 and 0.76). For laparoscopic hiatal hernia operations at top-ranked vs nonranked hospitals, patient outcomes were comparable for serious morbidity (1.62% vs 1.55%; P = .96), in-hospital mortality (0.12% vs 0.08%; P = .70), mean (SD) LOS (2.69 [2.67] days vs 2.54 [2.76] days; P = .10), and mean (SD) costs ($7116 [$5444] vs $7354 [$5649]; P = .96).
Table 3. Post hoc Analyses of Outcomes for Advanced Laparoscopic Abdominal Operations at Top-Ranked vs Nonranked Hospitals by Procedure Type.
| Outcome | Operations, No. (%) | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| Bariatric | Colorectal | Hiatal Hernia | |||||||
| Top-Ranked Hospitals (n = 10 275) | Nonranked Hospitals (n = 25 182) | P Value | Top-Ranked Hospitals (n = 4350) | Nonranked Hospitals (n = 7936) | P Value | Top-Ranked Hospitals (n = 1671) | Nonranked Hospitals (n = 2455) | P Value | |
| In-hospital mortality | 3 (0.03) | 4 (0.02) | .70 | 2 (0.05) | 19 (0.24) | .02 | 2 (0.12) | 2 (0.08) | .70 |
| Mortality index, O:E ratio | 0.56 | 0.42 | U | 0.16 | 0.76 | U | 0.27 | 0.19 | U |
| Serious morbidity | 53 (0.52) | 114 (0.45) | .48 | 92 (2.11) | 211 (2.66) | .07 | 27 (1.62) | 38 (1.55) | .96 |
| LOS, mean (SD), d | 1.97 (2.57) | 1.74 (1.32) | <.001 | 4.54 (4.24) | 4.34 (4.14) | .02 | 2.69 (2.67) | 2.54 (2.76) | .10 |
| Direct cost, mean (SD), US$ | 7091 (5503) | 6531 (3646) | <.001 | 9506 (9172) | 8905 (7112) | <.001 | 7116 (5444) | 7354 (5649) | .96 |
Abbreviations: LOS, length of stay; O:E, observed to expected; U, unable to undergo bivariate analysis.
Discussion
The USNWR specialty rankings are published annually and recognize hospitals that provide high levels of care for 12 specialties on the basis of performance scores in patient outcomes, institutional infrastructure and reputation, and quality indicators. Because the public uses these rankings to make decisions on where to obtain care, the current study aimed to determine whether an association exists between hospital ranking and improved patient outcomes after common advanced laparoscopic abdominal operations.
We found that the USNWR top-ranked hospitals performed a more than 3-fold higher case volume of advanced laparoscopic abdominal operations compared with nonranked hospitals. Despite the higher volume, no statistically significant difference in serious morbidity or in-hospital mortality was observed between the top-ranked vs nonranked hospitals. In addition, patients had a longer mean LOS and statistically significantly higher mean costs at top-ranked hospitals. This study appears to have demonstrated that the USNWR-ranked hospitals for gastroenterology and gastrointestinal surgical procedures does not necessarily imply improved patient outcomes for common gastrointestinal operations but can add additional costs to patients.
We found no statistically significant difference in patient outcomes between top-ranked and nonranked hospitals for common advanced laparoscopic abdominal operations. However, previous studies have found an association between the USNWR top-ranked hospitals and improved outcomes in cardiac and complex gastrointestinal operations.3,5,6 In a cross-sectional study of 3552 US hospitals, Wang and colleagues3 reported significantly lower 30-day mortality rates for acute myocardial infarction at top-ranked hospitals (11.9%) compared with nonranked hospitals (13.2%). Similarly, in a study of data from the Cooperative Cardiovascular Project involving 149 177 elderly Medicare beneficiaries with acute myocardial infarction, Chen and colleagues5 found that admission to the top-ranked USNWR hospitals was associated with lower 30-day mortality compared with nonranked hospitals. In a cross-sectional study that used the Medicare database to examine complex gastrointestinal operations, including esophagectomy, pancreatectomy, or colectomy for cancer, Osborne and colleagues7 found that the risk-adjusted mortality for these 3 complex procedures was significantly lower in the USNWR-ranked best hospitals.
The main explanation for the association between top-ranked hospitals and improved patient outcomes in these studies may be the high 30-day mortality rate associated with admission for acute myocardial infarction condition and complex operations such as esophagectomy and pancreatectomy. In contrast, the in-hospital mortality rate after common laparoscopic gastrointestinal operations in the current study was relatively low: the mortality rate was 0.04% at top-ranked hospitals and 0.07% at nonranked hospitals. In a study of the association between Centers for Medicare & Medicaid Services (CMS) Overall Hospital Quality Star Rating system and gastrointestinal procedure outcomes, Koh and colleagues8 similarly found that the CMS high-stars rating of a hospital did not signify improved patient outcomes for advanced laparoscopic abdominal operations compared with the CMS low-stars rating. Another finding was that patients who underwent laparoscopic colorectal operations at top-ranked hospitals had a decreased mortality rate and a lower risk-adjusted mortality index compared with nonranked hospitals. This finding may reflect a field in which top-ranked hospitals have in place the advanced structure for multidisciplinary management of this condition. In addition, the current study found that patients had higher costs and longer LOS at top-ranked hospitals compared with nonranked hospitals. We believe this difference to be multifactorial, owing to the complexity of patients and hospital costs associated with the institution’s size (number of hospital beds) and available technologies.9,10
Another reason for the association between top-ranked hospitals and improved patient outcomes in complex gastrointestinal operations may be the higher volume of cases performed at top-ranked hospitals compared with nonranked hospitals. In the current study, we found that top-ranked hospitals performed a more than 3-fold higher case volume compared with nonranked hospitals. Nevertheless, studies have documented the association of high-volume centers and high-volume surgeons with improved patient outcomes for complex gastrointestinal operations such as esophagectomy and pancreatectomy.11 Bariatric operations were previously found to have a similar association between volume and outcomes: better patient outcomes were associated with higher number (>100) of bariatric operations per year.12 However, mortality from bariatric operations has been decreasing over the past 2 decades, and thus the implication of volume for outcomes in bariatric surgery has lessened. In a study of the Nationwide Inpatient Sample, Gould and colleagues13 examined 32 509 bariatric procedures and found an overall low mortality of 0.12%. Although they observed that a volume-outcome association existed, the association appeared linear with no clear volume threshold that differentiated high- from low-volume centers.13
In the current study, we found that high ranking for gastroenterology and gastrointestinal surgical procedures from the USNWR was not a good proxy for the quality of surgical care for common advanced laparoscopic gastrointestinal operations. The USNWR has been criticized for its emphasis on subjective reputation and its role in the formulation of rankings.14,15,16 Besides the USNWR ratings, alternative ranking systems have been proposed, including Healthgrades, Consumer Reports, CMS Overall Hospital Quality Star Rating, and the American College of Surgeons National Surgical Quality Improvement Program Meritorious Hospital scoring.8,17,18 These ranking systems still may be inadequate. Raghuram and colleagues19 found little correlation among 4 different publicly available hospital ranking systems (USNWR, Healthgrades, CMS, and Society of Thoracic Surgeons) for coronary artery bypass graft or aortic valve replacement. It appears that further studies are needed into the best metrics and methods for assessing and comparing hospitals.
Limitations
This study has several limitations, including those inherent to a retrospective database study with selection bias and coding errors. The Vizient database lacked patient-level data, which limited its use for risk adjustment. However, for the primary outcome measure of mortality, we were able to use the O:E ratio to compare patient risk profiles between groups. The database is compiled from discharge data and lacked in-hospital data, and any complications or death occurring in the follow-up period may not have been captured. Therefore, our findings should be viewed with caution as in-hospital mortality and morbidity rates may be an underestimation of true overall mortality and morbidity rates. In addition, the database is composed of only academic centers and their affiliated hospitals. However, most USNWR-ranked hospitals are academic centers. Self-selection bias is associated with the USNWR ranking in that the top-ranked hospitals gain an advantage from the publicity generated, which increases patient volume and reputation that, in turn, enable the hospitals to remain on the ranking list. We did not have information on the actual size of top-ranked and nonranked hospitals and therefore were unable to establish whether the higher volume of cases performed at top-ranked hospitals was a reflection of a larger health system capable of handling more case volume.
As the current study stayed within the context of gastroenterology and gastrointestinal surgical procedures, its analysis was limited to perioperative outcomes of common laparoscopic gastrointestinal operations, without expanding to the outcomes of common endoscopic procedures, other gastroenterology and gastrointestinal surgical procedures such as an esophagectomy and pancreatectomy, and/or patient functional outcomes. However, morbidity and mortality associated with common endoscopic procedures tend to be low and will make it difficult to differentiate centers when analyzing low-morbidity procedures. Findings from this study represent commonly performed laparoscopic abdominal operations, including bariatric, colorectal, and hiatal hernia operations, and exclude other complex gastrointestinal operations such as esophagectomy and pancreatectomy.
Conclusions
Within the context of academic centers, the USNWR top-ranked hospitals performed 3-fold higher annual volume of advanced laparoscopic abdominal operations compared with nonranked hospitals. Despite the higher case volume, we suggest that no association was found between top-ranked hospitals and improved patient outcomes for common advanced laparoscopic gastrointestinal operations.
eAppendix. US News & World Report Gastroenterology and Gastrointestinal Surgery Ranking Methodology
References
- 1.Olmsted MG, Geisen E, Murphy J, et al. Methodology. US News & World Report 2017-18 best hospitals: specialty rankings. https://www.usnews.com/static/documents/health/best-hospitals/BH_Methodology_2017-18.pdf. Published September 7, 2017. Accessed October 5, 2018.
- 2.Pope DG. Reacting to rankings: evidence from “America’s Best Hospitals”. J Health Econ. 2009;28(6):1154-1165. doi: 10.1016/j.jhealeco.2009.08.006 [DOI] [PubMed] [Google Scholar]
- 3.Wang DE, Wadhera RK, Bhatt DL. Association of rankings with cardiovascular outcomes at top-ranked hospitals vs nonranked hospitals in the United States. [published online November 28, 2018]. JAMA Cardiol. 2018. doi: 10.1001/jamacardio.2018.3951 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Vizient Inc Co website. https://www.vizientinc.com/. Accessed July 10, 2018.
- 5.Chen J, Radford MJ, Wang Y, Marciniak TA, Krumholz HM. Do “America’s Best Hospitals” perform better for acute myocardial infarction? N Engl J Med. 1999;340(4):286-292. doi: 10.1056/NEJM199901283400407 [DOI] [PubMed] [Google Scholar]
- 6.Williams SC, Koss RG, Morton DJ, Loeb JM. Performance of top-ranked heart care hospitals on evidence-based process measures. Circulation. 2006;114(6):558-564. doi: 10.1161/CIRCULATIONAHA.105.600973 [DOI] [PubMed] [Google Scholar]
- 7.Osborne NH, Ghaferi AA, Nicholas LH, Dimick JB, Mph M. Evaluating popular media and internet-based hospital quality ratings for cancer surgery. Arch Surg. 2011;146(5):600-604. doi: 10.1001/archsurg.2011.119 [DOI] [PubMed] [Google Scholar]
- 8.Koh CY, Inaba CS, Sujatha-Bhaskar S, Nguyen NT. Association of Centers for Medicare & Medicaid Services Overall Hospital Quality Star Rating with outcomes in advanced laparoscopic abdominal surgery. JAMA Surg. 2017;152(12):1113-1117. doi: 10.1001/jamasurg.2017.2212 [DOI] [PubMed] [Google Scholar]
- 9.Gani F, Hundt J, Daniel M, Efron JE, Makary MA, Pawlik TM. Variations in hospitals costs for surgical procedures: inefficient care or sick patients? Am J Surg. 2017;213(1):1-9. doi: 10.1016/j.amjsurg.2016.05.007 [DOI] [PubMed] [Google Scholar]
- 10.Huber TS, Carlton LM, O’Hern DG, et al. . Financial impact of tertiary care in an academic medical center. Ann Surg. 2000;231(6):860-868. doi: 10.1097/00000658-200006000-00010 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11.Toomey PG, Teta AF, Patel KD, Ross SB, Rosemurgy AS. High-volume surgeons vs high-volume hospitals: are best outcomes more due to who or where? Am J Surg. 2016;211(1):59-63. doi: 10.1016/j.amjsurg.2015.08.021 [DOI] [PubMed] [Google Scholar]
- 12.Nguyen NT, Paya M, Stevens CM, Mavandadi S, Zainabadi K, Wilson SE. The relationship between hospital volume and outcome in bariatric surgery at academic medical centers. Ann Surg. 2004;240(4):586-593. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13.Gould JC, Kent KC, Wan Y, Rajamanickam V, Leverson G, Campos GM. Perioperative safety and volume: outcomes relationships in bariatric surgery: a study of 32,000 patients. J Am Coll Surg. 2011;213(6):771-777. doi: 10.1016/j.jamcollsurg.2011.09.006 [DOI] [PubMed] [Google Scholar]
- 14.Sehgal AR. The role of reputation in US News & World Report’s rankings of the top 50 American hospitals. Ann Intern Med. 2010;152(8):521-525. doi: 10.7326/0003-4819-152-8-201004200-00009 [DOI] [PubMed] [Google Scholar]
- 15.Prasad V, Goldstein JA. US News & World Report cancer hospital rankings: do they reflect measures of research productivity? PLoS One. 2014;9(9):e107803. doi: 10.1371/journal.pone.0107803 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16.Ingram DG, Bachrach BE. US News & World Report’s rankings of the top 50 children’s hospitals for diabetes and endocrinology reflect reputation more than objective measures. J Pediatr Endocrinol Metab. 2011;24(9-10):759-761. doi: 10.1515/JPEM.2011.293 [DOI] [PubMed] [Google Scholar]
- 17.Lascano D, Finkelstein JB, Barlow LJ, et al. . The correlation of media ranking’s “best” hospitals and surgical outcomes following radical cystectomy for urothelial cancer. Urology. 2015;86(6):1104-1112. doi: 10.1016/j.urology.2015.07.049 [DOI] [PubMed] [Google Scholar]
- 18.ACS National Surgical Quality Improvement Program ACS NSQIP meritorious hospitals. https://www.facs.org/quality-programs/acs-nsqip/meritorious. Accessed August 15, 2018.
- 19.Raghuram AC, Dasari TK, Chou B, et al. . Confusion instead of clarity: publicly reported cardiac surgery ratings for coronary artery bypass grafting and aortic valve replacement. J Am Coll Surg. 2019;228(2):180-187. doi: 10.1016/j.jamcollsurg.2018.07.663 [DOI] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
eAppendix. US News & World Report Gastroenterology and Gastrointestinal Surgery Ranking Methodology