Patients should be very wary of the validity of surgeon complication rates as described in the recent Bulletin article, “Most Central Oregon docs see moderate complication rates.” ProPublica, a nonprofit investigative journalism corporation based in New York, has used very limited data to determine the “safety” of over 17,000 surgeons in the U.S.

ProPublica’s method to identify complications was based solely on readmission of patients within 30 days of surgery. They chose surgeries such as spinal fusion, total hip replacement and prostatectomy based on their “relatively low risk.” There is no such thing as “low risk surgery” in my experience. Most serious complications of surgery such as heart attack, stroke, hemorrhage or blood clots occur within the first few days of the operation. These are treated during the initial admission, and ProPublica does not capture any of these events. Furthermore, in the medical literature there is a grading system for complications based on their severity. A wound infection is a grade 1 or 2 complication that is treated with oral or IV antibiotics. A bowel injury is a life-threatening grade 4 event that requires exploratory surgery and repair. Surgeons with patients readmitted for minor complications could be unfairly penalized. Surgeons with a preponderance of major complications could go unnoticed. ProPublica lumped all complications together, which resulted in a very unclear and inaccurate picture.

From a patient advocacy perspective this type of data is seemingly a good thing. It would empower patients to know who the “good” surgeons are, and would force the “bad apples” out of practice. But ProPublica’s self-proclaimed role as protector of the populace is laughable at best. Surgeons spend about a decade in residency and fellowships learning how to do their job. During that entire time, they are scrutinized, and those who pose a true technical or ethical risk are weeded out. Throughout their careers, they continue to be scrutinized by their peers, the hospital administration, the medical board and their specialty boards. This auto regulation among medical professionals has been, and always will be, the ultimate safeguard against bad practice.

The Bulletin listed individual Bend surgeons and their complication rates on their front page. What good purpose could this possibly serve? In the case of knee replacement, Dr. Knute Buehler had the lowest complication rate of 1.5 percent, while Dr. Timothy Bollom came in with the highest at 2.6 percent. Both of these complication rates are highly respectable for this major surgery. While there is a statistical difference between 1.5 percent and 2.6 percent, in the real world such a discrepancy is meaningless. Next year these percentages could switch based on probability alone. The Bulletin has done the medical providers and patients in this community a disservice by being complicit in ProPublica’s bogus ratings scheme.

Ultimately, this grading system hurts communities and society as a whole. The reporting system has been devised so that Medicare can adjust reimbursement based on complication rates: the so-called “pay-for-performance” system. Surgeons who take on tough cases play a vital role in the community. Because their patients’ problems are more severe, their complication rates after surgery are inevitably higher. The grading system directly poses a double threat to these surgeons — if you have complications you will be paid less and your “inferior performance” will be advertised in public. Surgeons will avoid taking risky cases, and this will limit or deny care to high- risk patients.

— Matthew Simmons, M.D., Ph.D., and Andrew Neeb, M.D., Urology Specialists of Oregon, Bend.