Variation in Patient-reported Outcomes Across Hospitals Following Surgery

Med Care. 2015 Nov;53(11):960-6. doi: 10.1097/MLR.0000000000000425.


Background: Although there is growing interest in applying patient-reported outcomes (PROs) toward surgical quality, the extent to which PROs vary across hospitals following surgical procedures is unknown.

Objectives: We examined variation in PROs, specifically health-related quality of life (HRQOL), across hospitals performing bariatric surgery.

Research design: A retrospective cohort study.

Subjects: The Michigan Bariatric Surgery Collaborative is a statewide consortium of 39 hospitals performing laparoscopic gastric bypass, gastric banding, or sleeve gastrectomy (n=11,420 patients between 2008 and 2012).

Measures: We examined generic and disease-specific HRQOL measured by the Health and Activities Limitations Index (HALex) and Bariatric Quality of Life index (BQL) preoperatively and at 1 year. We measured the variation in postoperative HRQOL across hospitals, and the effect of risk and reliability adjustment on hospital ranking.

Results: In this cohort, HRQOL varied by 56% (HALex) and 37% (BQL) across hospitals. Patient factors accounted for 58% (HALex) to 71% (BQL) of the variation in HRQOL across hospitals. After risk and reliability adjustment, HRQOL varied by 18% (by HALex) and 14.5% (by BQL) across hospitals, and the proportion of patients who experienced a large improvement in HRQOL by HALex ranged from 33% to 69% and 67% to 92% by BQL. After adjusting for patient factors and reliability, these differences diminished to 55%-64% (HALex) and 79%-84% (BQL).

Conclusions: Patient factors explain a large proportion of hospital-level variation in PROs following bariatric surgery, underscoring the importance of risk adjustment. However, some variation in PROs across hospitals remains unexplained, suggesting PROs may represent a viable indicator of hospital performance.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Bariatric Surgery / psychology*
  • Bariatric Surgery / statistics & numerical data
  • Cohort Studies
  • Factor Analysis, Statistical
  • Humans
  • Michigan
  • Obesity, Morbid / surgery
  • Outcome and Process Assessment, Health Care*
  • Patient Satisfaction / statistics & numerical data*
  • Postoperative Complications / epidemiology
  • Postoperative Complications / psychology*
  • Quality of Life / psychology*
  • Retrospective Studies
  • Surveys and Questionnaires
  • Treatment Outcome