Use of unsolicited patient observations to identify surgeons with increased risk for postoperative complications

William O. Cooper, Oscar Guillamondegui, O. Joe Hines, Charles Hultman, Rachel R. Kelz, Perry Shen, David A. Spain, John F. Sweeney, Ilene N. Moore, Joseph Hopkins, Ira R. Horowitz, Russell M. Howerton, J. Wayne Meredith, Nathan O. Spell, Patricia Sullivan, Henry J. Domenico, James W. Pichert, Thomas F. Catron, Lynn E. Webb, Roger R. Dmochowski & 2 others Jan Karrass, Gerald B. Hickson

Research output: Contribution to journalArticle

Abstract

IMPORTANCE 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. OBJECTIVE 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. DESIGN, SETTING, AND PARTICIPANTS 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. EXPOSURES Unsolicited patient observations for the patient's surgeon in the 24 months preceding the date of the operation. MAIN OUTCOMES AND MEASURES Postoperative surgical or medical complications as defined by the National Surgical Quality Improvement Program within 30 days of the operation of interest. RESULTS 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. CONCLUSIONS AND RELEVANCE 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.

Original languageEnglish (US)
Pages (from-to)522-529
Number of pages8
JournalJAMA surgery
Volume152
Issue number6
DOIs
StatePublished - Jun 1 2017
Externally publishedYes

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Quality Improvement
Odds Ratio
Surgeons
Patient Advocacy
Malpractice
Physician-Patient Relations
Patient Safety
Inpatients
Cohort Studies
Outpatients
Retrospective Studies

ASJC Scopus subject areas

  • Surgery

Cite this

Cooper, W. O., Guillamondegui, O., Hines, O. J., Hultman, C., Kelz, R. R., Shen, P., ... Hickson, G. B. (2017). Use of unsolicited patient observations to identify surgeons with increased risk for postoperative complications. JAMA surgery, 152(6), 522-529. https://doi.org/10.1001/jamasurg.2016.5703

Use of unsolicited patient observations to identify surgeons with increased risk for postoperative complications. / Cooper, William O.; Guillamondegui, Oscar; Hines, O. Joe; Hultman, Charles; Kelz, Rachel R.; Shen, Perry; Spain, David A.; Sweeney, John F.; Moore, Ilene N.; Hopkins, Joseph; Horowitz, Ira R.; Howerton, Russell M.; Meredith, J. Wayne; Spell, Nathan O.; Sullivan, Patricia; Domenico, Henry J.; Pichert, James W.; Catron, Thomas F.; Webb, Lynn E.; Dmochowski, Roger R.; Karrass, Jan; Hickson, Gerald B.

In: JAMA surgery, Vol. 152, No. 6, 01.06.2017, p. 522-529.

Research output: Contribution to journalArticle

Cooper, WO, Guillamondegui, O, Hines, OJ, Hultman, C, Kelz, RR, Shen, P, Spain, DA, Sweeney, JF, Moore, IN, Hopkins, J, Horowitz, IR, Howerton, RM, Meredith, JW, Spell, NO, Sullivan, P, Domenico, HJ, Pichert, JW, Catron, TF, Webb, LE, Dmochowski, RR, Karrass, J & Hickson, GB 2017, 'Use of unsolicited patient observations to identify surgeons with increased risk for postoperative complications', JAMA surgery, vol. 152, no. 6, pp. 522-529. https://doi.org/10.1001/jamasurg.2016.5703
Cooper, William O. ; Guillamondegui, Oscar ; Hines, O. Joe ; Hultman, Charles ; Kelz, Rachel R. ; Shen, Perry ; Spain, David A. ; Sweeney, John F. ; Moore, Ilene N. ; Hopkins, Joseph ; Horowitz, Ira R. ; Howerton, Russell M. ; Meredith, J. Wayne ; Spell, Nathan O. ; Sullivan, Patricia ; Domenico, Henry J. ; Pichert, James W. ; Catron, Thomas F. ; Webb, Lynn E. ; Dmochowski, Roger R. ; Karrass, Jan ; Hickson, Gerald B. / Use of unsolicited patient observations to identify surgeons with increased risk for postoperative complications. In: JAMA surgery. 2017 ; Vol. 152, No. 6. pp. 522-529.
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abstract = "IMPORTANCE 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. OBJECTIVE 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. DESIGN, SETTING, AND PARTICIPANTS 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. EXPOSURES Unsolicited patient observations for the patient's surgeon in the 24 months preceding the date of the operation. MAIN OUTCOMES AND MEASURES Postoperative surgical or medical complications as defined by the National Surgical Quality Improvement Program within 30 days of the operation of interest. RESULTS 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. CONCLUSIONS AND RELEVANCE 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.",
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T1 - Use of unsolicited patient observations to identify surgeons with increased risk for postoperative complications

AU - Cooper, William O.

AU - Guillamondegui, Oscar

AU - Hines, O. Joe

AU - Hultman, Charles

AU - Kelz, Rachel R.

AU - Shen, Perry

AU - Spain, David A.

AU - Sweeney, John F.

AU - Moore, Ilene N.

AU - Hopkins, Joseph

AU - Horowitz, Ira R.

AU - Howerton, Russell M.

AU - Meredith, J. Wayne

AU - Spell, Nathan O.

AU - Sullivan, Patricia

AU - Domenico, Henry J.

AU - Pichert, James W.

AU - Catron, Thomas F.

AU - Webb, Lynn E.

AU - Dmochowski, Roger R.

AU - Karrass, Jan

AU - Hickson, Gerald B.

PY - 2017/6/1

Y1 - 2017/6/1

N2 - IMPORTANCE 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. OBJECTIVE 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. DESIGN, SETTING, AND PARTICIPANTS 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. EXPOSURES Unsolicited patient observations for the patient's surgeon in the 24 months preceding the date of the operation. MAIN OUTCOMES AND MEASURES Postoperative surgical or medical complications as defined by the National Surgical Quality Improvement Program within 30 days of the operation of interest. RESULTS 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. CONCLUSIONS AND RELEVANCE 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.

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