Evaluating popular media and internet-based hospital quality ratings for cancer surgery

Arch Surg. 2011 May;146(5):600-4. doi: 10.1001/archsurg.2011.119.


Objective: We sought to determine whether "best hospitals," as defined by the US News & World Report or HealthGrades, have lower mortality rates than all other American hospitals for cancer surgery.

Design: Retrospective cross-sectional study.

Setting: Medicare database (2005-2006).

Patients: All patients with a diagnosis of malignancy who underwent pancreatectomy, esophagectomy, and colectomy (n = 82,724).

Main outcomes measures: Risk-adjusted mortality rates at best hospitals according to both the US News & World Report and HealthGrades, was compared with all other US hospitals, adjusting for differences in patient factors and surgical acuity. Risk-adjusted mortality rates between best hospitals and all other hospitals was compared after controlling for differences in hospital volume.

Results: Risk-adjusted mortality was significantly lower in US News & World Report best hospitals for all 3 procedures: pancreatectomy (odds ratio [OR], 0.42; 95% confidence interval [CI], 0.30-0.58), esophagectomy (OR, 0.48; 95% CI, 0.37-0.62), and colectomy (OR, 0.69; 95% CI, 0.55-0.86). Risk-adjusted mortality was significantly lower in HealthGrades best hospitals for colectomy (OR, 0.79; 95% CI, 0.65-0.95). However, after accounting for hospital volume, risk-adjusted mortality was only significantly lower at the US News & World Report best hospitals for colectomy (OR, 0.79; 95% CI, 0.62-0.99) and was not significantly lower at HealthGrades best hospitals for any of the 3 oncologic procedures.

Conclusions: Publicly marketed hospital rating systems of surgical quality such as the US News & World Report "America's Best Hospitals" and HealthGrades "Best Hospitals" may identify high-quality hospitals for some oncologic surgeries. However, these ratings fail to identify other high-volume hospitals of equal quality.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Cancer Care Facilities / standards*
  • Colectomy / mortality*
  • Colonic Neoplasms / mortality*
  • Colonic Neoplasms / surgery*
  • Confidence Intervals
  • Cross-Sectional Studies
  • Esophageal Neoplasms / mortality*
  • Esophageal Neoplasms / surgery*
  • Esophagectomy / mortality*
  • Female
  • Health Care Surveys / statistics & numerical data*
  • Health Services Research / statistics & numerical data*
  • Hospital Mortality*
  • Humans
  • Male
  • Medicare / statistics & numerical data
  • Middle Aged
  • Newspapers as Topic / statistics & numerical data*
  • Odds Ratio
  • Outcome Assessment, Health Care / statistics & numerical data
  • Pancreatectomy / mortality*
  • Pancreatic Neoplasms / mortality*
  • Pancreatic Neoplasms / surgery*
  • Public Opinion
  • Quality Indicators, Health Care / statistics & numerical data*
  • Quality of Health Care / statistics & numerical data*
  • Retrospective Studies
  • Risk Adjustment / statistics & numerical data*
  • United States