Yes, you can now check your prostate cancer surgeon’s complication rates, but …


… You are going to need to be cautious in using this new tool, as explained below.

The new tool we are referring to is the “Surgeon Scorecard” developed and just made available by the not-for-profit consumer advocacy organization ProPublica. And before we tell you how to access this tool, it is important that we explain what it is based on.

First, it is based exclusively on Medicare-related data from 2009 to 2013, and therefore on results from Medicare patients, so if a particular surgeon operates on low numbers of Medicare patients his or her data will not be available through this system. On the other hand, one can reasonably expect that surgeons who have low numbers of complications on Medicare patients would also have low numbers of complications on non-Medicare patients.

Second, the developers did try to take account of patient co-morbidities in developing this database. They screened each patient’s record for signs of health problems other than the actual problem being treated surgically (e.g., obesity and diabetes) and then assigned each patient a health score before calculating an individual surgeon’s adjusted complication rate.

Basically, you can use the Surgeon Scorecard to look at the complication rates at specific institutions (e.g., Johns Hopkins in Baltimore) or specific surgeons (e.g., Alan Partin, MD, the Chairman of the Urology Department at Johns Hopkins). We have called out Johns Hopkins for a reason. The Johns Hopkins radical prostatectomy data deals with 11 of their surgeons by name. You will see that Dr. Partin has the lowest complication rate among the group and that another surgeon has a much higher complication rate than his peers. This is a point emphasized by ProPublica in their information about the release of this database. However, what we do need to be very cautious about is the question of whether the surgeon with the high complication rate is actually operating on similar patients to the other Johns Hopkins surgeons. If that surgeon is, for example, very deliberately focusing on surgical treatment of high-risk patients and/or men with radiation-recurrent prostate cancer, then it would be completely reasonable to expect him to have a much higher complication rate than his peers. We suspect that this may, in fact, be the case at Johns Hopkins.

So … yes, this is a very interesting tool for patients and others to be able to use to assess the skill levels of prostate cancer surgeons … but, you can’t take these data as some sort of absolute truth because they need to be looked at in context. On the other hand, they do allow you to see what the general level of complications is at particular hospitals — and that is liable to have greater validity than the data for any one individual surgeon.

Here’s how we think the average patient can best access the tool:

  1. Go to the main web page for the Surgeon Scorecard.
  2. To look for hospitals in your general area using the “Find New Me” tab. For example, enter “Baltimore, Maryland” into the space where it ask for “Surgeons and Hospitals Near My Location”
  3. Select “Prostate removal” as the surgery type and click the search icon. The resulting page will show you links to five hospitals in the Baltimore area for which data are available.
  4. Click on the link to Johns Hopkins Hospital and you will get to this page, which gives you information on complication rates for six different types of surgery carried out at Johns Hopkins.
  5. Click on the link to Prostate removal (as opposed to Prostate resection, which means a TURP) and you will get to this page, which shows the complication rates for radical prostatectomy for the 11 surgeons at Johns Hopkins for whom data are available.

You can carry out similar searches for any region in the USA or you can also search by individual physician or by individual institution.

Again, we are going to emphasize that this tool is interesting but needs to be used with care. It will probably be of great value to prostate cancer support group leaders in looking at the complication rates for surgeons in their areas of the country … but don’t take all the data too literally. Be aware that there may be reasons for “outlier” results like the one mentioned above.

For those who are interested in reading more about this system and how ProPublica created it, here are some relevant links:

  • Click here to see the story ProPublica used to promote this tool to the media and to consumers.
  • Click here to see how ProPublica actually created the tool and understand the data on which it is based.
  • And there is also a list of “FAQs” for those who may have questions about the tool and the data used to create it.

9 Responses

  1. Why is there no data for Memorial Sloan-Kettering in NYC? I believe they do a few prostatectomies there.

  2. Mr. White:

    They may not do enough Medicare patients at MSKCC. And they would only do one of the eight procedures assessed by the full system. As a consequence they may not have been an evaluated institution.

  3. I cannot believe that MSKCC, because of its size and national rating as a cancer treatment hospital, does not do enough Medicare procedures annually (prostatectomies) to be evaluated. Something is not right here.

  4. Dear Mr. White:

    You appear to only have read half my prior reply. The other reason that they may not be included in the database is because MSKCC would probably only do one of the eight procedures analyzed by ProPublica (covered by Medicare or otherwise). As far as I can tell, most of the institutions included in the database do at least five or six of the procedures.

  5. Interesting that Walsh had higher complication rates than Partin. … Didn’t Walsh pioneer the nerve-sparing procedure as well as greatly reduce the post-operative effects of incontinence and ED through many years of anatomy research? Good thing I chose Partin over the guy that re-invented the operation. …

    Didn’t Mark Twain say, there are liars, da?? liars and then there are statistics. …

  6. They do list James Eastham and Peter Scardino (surgeons at MSKCC), and they give the address of MSKCC for them, but you can’t find them by inputting “Memorial Sloan Kettering.” They list “City of Hope” — also a cancer center — but I guess they did enough hip and knee replacements there to qualify for inclusion.

    I think the best use for this is to get a relative feel for the volume of each surgeon one is interested in.

  7. Chris:

    Dr. Walsh was born in about 1938 I believe. That would make him 77 years of age now and he would have been 73 in 2009. The study database for this tool was patients treated between 2009 and 2013. By comparison, Dr. Partin is some 20 years younger and would have been about 49 in 2009.

    With the best will in the world, one’s skills as a surgeon do decline as one gets older, and I am not even sure that Dr. Walsh operates at all any more.

  8. Dr. Walsh performed his final prostatectomy, his 4,569th, on June 29, 2011.

    An important factor NOT accounted for or mentioned here is the distribution of the portfolio of risk levels that each physician operated on. Someone who primarily operates on 3 + 3 cases will have a much different aggregated result than someone who took on more aggressive cases.

  9. Dear Casey:

    While “the distribution of the portfolio of risk levels that each physician operated on” is not addressed in the Surgeon Scorecard tool, I would point out that we did, very deliberately, make that point in the commentary above — and with very specific reference to Johns Hopkins for exactly the reason you note.

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