Why is tracking complications so important?
Millions of total joint replacement surgeries are performed each year in the US. While the vast majority of patients experience tremendous outcomes, 2-5% have complications that require additional surgery. What we do not know is why- and that needs to change. The most direct way to find out the ‘why’ and improve surgical outcomes is through data. Joint Replacement surgery provides a tremendous value to society at large. Millions of patients every year have improved activity levels, decreased pain, and a better quality of life after undergoing a total joint replacement surgery. But on occasion, things do not go according to plan, and patients suffer from a complication. These complications can range from post-operative bleeding and superficial infection to dislocation or fracture.
Atual Gawande has famously written a book, Complications, about the sacred and secret world of surgical complications. The reality is that humans are imperfect creatures and surgeons are no different. Incredibly well trained, they work tirelessly to give each patient the best possible care, but unfortunately, no matter how hard they try or how much they care about each patient… complications happen.
It is known that 2-5% of all patients who have total joint replacement surgery will have a complication that requires additional surgery. What is not known, however, is why. While the percentage is rather small, the impact associated with these complications is big – Real BIG! In addition to the fact that the patients who are unlucky enough to belong to this 2-5% club suffer drastically, the additional costs and worst outcomes associated with total joint replacement complications drive down the value of a surgical intervention as a whole. As the healthcare marketplace continues to evolve, elective orthopedic procedures are under the scrutiny of payers. In order to illustrate the tremendous value these elective orthopedic surgeries have to society at large, it is critical to have outcome data that justifies the value is worth the cost. Analyzing complication data is the most direct route to learning why most patients do fine, yet a few experience complications. The problem is, hardly anyone is actually doing it.
What are the barriers to tracking complications?
So, why don’t most surgeons track complications? For one, collecting outcome data is hard to do – Surgeons are very busy taking the best possible care of patients and don’t have time to catalog patient outcome data. The other reason is that the majority of patients (65.6%, in fact) that have a complication go to a different surgeon or facility, making it nearly impossible to keep track of.
When insurers and regulatory bodies are following and reporting complication rates tracking and monitoring your practice’s complications is more critical than ever. So, how will surgeons accomplish this time-consuming endeavor? Ironically, the answer may be as simple as just asking the patient. As we discussed in Validity of Patient-Reported Complications: 6 Important Points”, studies in prominent orthopedic journals have validated patients’ accurately self-reporting data related to complications. However, it also points out that more than half of these patients will not return to their primary surgeon’s clinic. These verify a surgeon’s ability to collect reliable data related to surgical complications by implementing a sustainable system for collecting patient-reported outcome data outside of the clinic.
If you are a surgeon you should ask yourself, “In an age when my value is calculated by dividing my patients’ outcomes by the cost of intervention, can I afford to capture less than half of the complications?” These complications jeopardize your value in the marketplace, and all you have to do is ask your patients. Our recommendation as outcomes experts is to start implementing your own patient-reported outcomes program because someone else is already tracking your complications.
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