Six tips for choosing the right hospital for surgery

Think that you should head to a famous medical center when you need surgery, regardless of where it’s located or whether your insurer will pay for it? That’s not surprising: Lately we’ve been bombarded with ads on TV and radio touting certain hospitals for their cutting-edge technology and high surgical success rates.

But getting trustworthy information about hospitals has long been hard to come by. Fortunately, that’s changing, because the government now requires them to report infection rates and other complications. And that information, along with analyses from our own hospital Ratings, suggests that many assumptions people make about what to look for in a hospital simply aren’t true. For example, although some difficult or rare surgeries require special expertise or a particular medical center, most procedures can be done safely and well by board-certified surgeons at hundreds of U.S. hospitals.

Here are six tips on what to focus on when choosing a hospital for surgery.

Yes, some big-name hospitals do really great work. But our latest surgery Ratings show that many lesser-known hospitals also do well at several common surgeries, including hip and knee replacements, coronary artery bypass surgery, and aortic valve replacement. For instance, well-known Mayo Clinic hospitals in Arizona, Florida, and Minnesota earned top scores for hip surgery, knee surgery, or both. But also doing well was the Siouxland Surgery Center in Dakota Dunes, S.D., which earned a top score for knee surgery, and Thomas Hospital in Fairhope, Ala., which did well for hip surgery. Heart surgery is no different. Of the 15 hospitals that received our top scores for bypass and aortic valve surgery, only one—the Cleveland Clinic—is known nationwide. Lesser-known places making the list were Mother Frances Hospital-Tyler in Tyler, Texas, and the Borgess Medical Center in Kalamazoo, Mich.

Those hospitals, which are held out as examples of the nation’s best medical care—and are often the recipients of generous federal funding—didn’t distinguish themselves in our surgery Ratings. Though some did rate high, on average they performed no better than other hospitals. Lisa McGiffert, head of the Consumer Reports Safe Patient Project, says that care at teaching hospitals can be top-notch, but it can also be impersonal, with disjointed care from a large, frequently changing staff.

“Hospitals are actively seeking patients and are trying to put their best face on what they think are their high-quality services,” says Carol Cronin, executive director of the nonprofit Informed Patient Institute. But the ads often don’t give consumers a realistic picture of the risks and benefits of treatment. A recent study in the Annals of Internal Medicine assessed ads by 102 cancer centers in top media markets. It found that they were geared to appeal to emotions. “How patients fare is what matters, not a compelling story,” says John Santa, M.D., medical director of the Consumer Reports Health Ratings Center.

You should focus on such information as the percentage of patients who develop dangerous infections in a hospital or have to be readmitted soon after they’re discharged, often a sign that something went wrong or wasn’t done right in the hospital. “And, of course, you should consider mortality—the percentage of patients who die while they are in the hospital,” Santa says. That data can be more useful than what other people, even experts, think of an institution, says Peter Cram, M.D., director of general internal medicine at the University Health Network and Mount Sinai Hospitals in Ontario, who has studied hospital rankings. Read more about how we rate hospitals on mortality.

Many people worry about the care available at rural and inner-city hospitals. Those institutions face special challenges, such as fewer resources. But we found several urban hospitals that scored well in our overall surgery measure, despite often serving poorer, sicker patients, including Mount Sinai Hospital in New York and University Hospitals Case Medical Center in Cleveland. And rural hospitals scored better overall, on average, than other hospitals.

Smaller hospitals can also provide excellent care. For example, a large hospital might do 1,000 knee replacements per year but have 20 surgeons. By contrast, a smaller hospital might do only 500 per year but by just one excellent surgeon. “That can be as good as it gets,” Cram says.

Research suggests that how frequently hospitals do a procedure can be an important measure to consider. “If you have no better or precise information about the proficiency or outcomes of a hospital, considering volume is better than throwing a dart at a dartboard,” says John D. Birkmeyer, M.D., a professor of surgery at the University of Michigan Health System in Ann Arbor. That might be especially true for complicated procedures, such as surgery to bypass clogged coronary arteries or to treat pancreatic cancer.

Safety in surgery numbers

It's hard to say how many operations a surgeon needs to do to become proficient. But are the minimum for severn operations, according to John D. Birkmeyer, M.D., a professor of surgery at the University of Michigan Health System in Ann Arbor.

A guide to hospital guides

Our hospital Ratings, which rely on publicly reported data and use our familiar symbols, take into account data from more than 4,500 hospitals in all 50 states plus Washington D.C., and Puerto Rico. That makes the Ratings one of the largest tools available to help consumers compare hospitals. They have information on up to 34 performance and safety measures, including:

• Infection, mortality, readmission, and C-section rates.
• Adverse event rates for 27 surgeries combined and for five specific surgeries (knee replacement, hip replacement, back surgery, angioplasty, and carotid artery surgery).
• Patient experience information for pain control, room cleanliness, communication with doctors and nurses, and other concerns.
• Heart surgery outcomes for bypass surgery and valve replacement.

Other hospital guides

Because hospitals are complex places, it’s wise to get information from a variety of sources. Here is a summary of some of the guides available:

• The Commonwealth Fund. Geared toward health care professionals. Good information, but it can be complicated for consumers to use.
• Healthgrades. Doesn’t reveal how it scores hospitals using its five-star scale. It works with hospitals on how they can improve their scores and use them to attract patients.
• Hospital Compare. This government tool uses data from Medicare and more than 4,000 hospitals to help you compare facilities on whether they’re below average, average, or above average on a number of key measures.
• Hospital Inspections. Established by the Association of Health Care Journalists, it focuses on violations and inspection reports.
• The Joint Commission. Hospitals receive a checkmark for each set of measures they have met. But there’s no way to tell whether a hospital is stronger in one area over another, or how a hospital stacks up against others.
• The Leapfrog Group. Use your city, state, and ZIP code to search more than 2,500 hospitals. But unless you have a background in statistics, it can be hard to put scores for individual measures into perspective.
• U.S. News & World Report Best Hospitals. Identifies the “best” hospitals for 16 specialties. Emphasizes reputation, not data, by giving substantial weight to physician opinions.

This article also appeared in the September 2014 issue of Consumer Reports on Health.

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