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Use of patient complaints to identify surgeons with increased risk for postoperative complications

February 15, 2017

Patients whose surgeons had a history of higher numbers of patient complaints had an increased risk of surgical and medical complications, according to a study published online by JAMA Surgery.

Patient complaints are associated with risk of medical malpractice claims. Because lawsuits may be triggered by an unexpected adverse outcome superimposed on a strained patient-physician relationship, a question remains as to whether behaviors that generate patient dissatisfaction might also contribute to the genesis of adverse outcomes themselves.

William O. Cooper, M.D., M.P.H., of Vanderbilt University Medical Center, Nashville, Tenn., and colleagues used data from seven academic medical centers and included patients who underwent inpatient or outpatient operations, and examined unsolicited patient observations (patient complaints) provided to a patient reporting system for the patient's surgeon in the 24 months preceding the date of the operation. Some patient complaints described behaviors that might intimidate or deter communication; others included patients' observations of a physician's disrespectful or rude interaction with other health care team members that might distract focus.

Among the 32,125 patients in the study, 3,501 (11 percent) experienced a complication, including 5.5 percent surgical and 7.5 percent medical. The researchers found that prior patient complaints for a surgeon were significantly associated with the risk of a patient having any complication, any surgical complication, any medical complication, and being readmitted. The adjusted rate of complications was 14 percent higher for patients whose surgeon was in the highest quartile of patient complaints compared with patients whose surgeon was in the lowest quartile.

"If extrapolated to the entire United States, where 27,000,000 surgical procedures are performed annually, failures to model respect, communicate effectively, and be available to patients could contribute to more than 350,000 additional complications and more than $3 billion in additional costs to the U.S. health care system each year," the authors write.

"Efforts to promote patient safety and address risk of malpractice claims should continue to focus on surgeons' ability to communicate respectfully and effectively with patients and other medical professionals."
(JAMA Surgery. Published online February 15, 2017.doi:10.1001/jamasurg.2016.5703. This study is available pre-embargo at the For The Media website.)

Editor's Note: This study presents independent research that was funded through the Vanderbilt Center for Patient and Professional Advocacy. No conflict of interest disclosures were reported.

Related material: The commentary, "Association of Unsolicited Patient Observations With the Quality of a Surgeon's Care," by Allen Kachalia, M.D., J.D., of Brigham and Women's Hospital, Harvard Medical School, Boston, and colleagues also is available at the For The Media website.

To place an electronic embedded link to this study in your story: This link will be live at the embargo time:

The JAMA Network Journals

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