Wall Street Journal Reports on Surgical Risk Calculators

Wall Street Journal Reports on Surgical Risk Calculators

“The Informed Patient” column of the February 2, 2010 issue of the Wall Street Journal contains an interesting article on the increased use of formalized risk calculators by surgeons to help reduce medical errors and to improve patient understanding of the risks involved in surgical procedures. For some time now, cardiac surgeons have been using risk calculators prepared by the Society of Thoracic Surgeons to predict the risk of death and complications from heart-bypass and other cardiac surgeries. Now the American College of Surgeons has introduced similar calculators for surgery of the colon and pancreas and is preparing similar tools or an additional 18 surgical procedures, including gastric bypass, hernia repair and prostate surgery. The implementation of these calculators will have major positive impacts on patient care and may help to provide clearer standards of what constitutes accepted levels of care in medical malpractice cases.

Scope of the Problem:
Surgery is big business in the United States. Annually more than 30 million operations are performed in the U.S. to remove deadly cancers, repair diseased organs and replace worn-out joints. It is also a risky business, with the risks increasing with a patient’s age. According to the nonprofit Institute for Healthcare Improvement, in about 10 percent of cases (2.5 to 3.5 million), patients experience adverse, unintended harm from surgery. Although some of these adverse consequences are unavoidable, a significant portion are the result of surgical errors and omissions, such as failing to provide a patient with pre-surgery antibiotics to reduce the risk of post operative infection. These complications are expensive. According to the WSJ article, the Centers for Disease Control and Prevention estimates that there are about 290,000 surgical-site infections each year, resulting in treatment costs ranging from $ 3 billion to $10 billion annually.
The American College of Surgeons' quality-improvement program follows a model implemented by the Veterans Health Administration that reduced deaths at VA hospitals from surgery by 27% and complications by 45%. A recent study showed that risk calculators helped over 100 hospitals prevent 262 to 524 complications annually, with an average savings of $3 million.

But a study published last September in the Annals of Surgery found that it helped 118 hospitals prevent from 262 to 524 complications per year, saving each an average of $3 million.

How it Works:
A risk calculator takes a patient's risk variables and in a matter of minutes produces a customized report outlining the risk of death and specific complications that a patient may face. In colorectal surgery, the risk calculator factors 15 variables to help predict complications and death within 30 days of surgery. These factors include patient age, body mass index, extent of disease—whether it is cancer or a digestive disease—and how much of the colon must be removed.
The report emphasizes to the surgeons what risks each patient faces and helps focus the procedures to reduce the risks, thereby eliminating mistakes and increasing the likelihood of favorable surgical results.

Other Uses:
In addition to providing objective measurements of risk, the use of calculators helps physicians in giving patients hard facts about what may happen, thereby making sure that the patients understand what may happen to them so that they may give “informed consent” to the their doctors. In essence, the reports give the physicians a tight script from which they can accurately tell the patient about the risk factors involved in a procedure. Any one who has faced the prospects of surgery knows how difficult it is to understand what are the real risks of a procedure and how difficult it is for many physicians to express the risks in understandable terms. This should become less of a problem as risk calculators become more common.

However, as personal injury lawyers, we see another use of these risk calculations. They undoubtedly will become standards by which claims of medical malpractice will be assessed. A physician who obtains a risk calculation and accurately informs his/her patient of the risks faces a greatly reduced chance of a medical malpractice claim if there is an adverse, unintended response. On the flip side, a physician who operates on a patient without a risk calculation or when the risks are deemed to be high, faces a greater chance that he/she will be targeted for a medical malpractice claim. Certainly, the developers of the risk calculators are aware of these potential collateral uses of the product and they probably will be rigorously analyzed to see if they are biased or slanted to deflect lawsuits.

Conclusion:
The development of risk calculators for the most common types of surgical procedures seems to be a positive step in eliminating unnecessary medical errors, thereby reducing patient mortality and health care costs. They also will help surgeons to communicate with patients in an objective manner about the true risks of procedures and thus will make patients more knowledgeable and accountable for their medical decisions. Finally, objective standards will make it easier to determine actionable medical malpractice exits, thereby making it easier to analyze and resolve these claims.

-Tom Barron

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