It depends on what you read.
A study of over 34,000 surgical procedures performed at a hospital system in Texas showed that 1,820 (5.3%) patients suffered complications. Charges for patients with complications who had private insurance resulted in significantly higher contribution margins (revenue minus variable expenses) to hospitals by some $39,000 compared with patients without complications. Contribution margins were significantly higher for Medicare patients with complications as well, but the difference was only $1,749.
The paper, by researchers from Harvard Medical School and others, was published in JAMA and created a considerable stir when it appeared.
A typical story about it was headlined “Hospitals ‘Profit Handsomely’ from Surgical Errors.” One of the co-authors of the study was quoted as saying, “It’s shocking, crazy and perverse that hospitals are being financially rewarded for harming patients.”
A major problem with the study is in the methods, which state “A subset of 10 potentially preventable, severe surgical complications was identified in our data set.”
However, all complications are not necessarily caused by errors, nor can they all be prevented.
Here are the complications: surgical site infection (SSI), wound disruption, sepsis/severe inflammatory response syndrome/septic shock, pulmonary embolism or deep vein thrombosis, stroke, myocardial infarction, cardiac arrest, pneumonia, ventilator use of 96 hours or longer, and infections (other than surgical site). Even when patient care is perfect, it is impossible to prevent every single infection, deep vein thrombosis, or any of the other complications listed. For example, a postoperative myocardial infarction can occur in the absence of any mistake by a caregiver, and so on.
A few months later, a paper by a group from Johns Hopkins came up with a completely different conclusion. Of course, it received no media coverage.
The study comprised 17,392 surgical procedures with 547 SSIs in the financial analysis subset.
The financial impact of SSIs on hospitals in their system showed that although patients with SSIs had significantly longer hospital stays and rates of readmission compared with those without an infection, their total hospital charges were not significantly different, at $7,493 and $7,924, respectively.
The authors found that if all of the SSIs were eliminated, on an annual basis, the health system would experience a cost increase of $2,606,865 and a billable capacity increase of 103 admissions. This would result in a revenue increase of $3,255,034. In other words, eliminating SSIs would free up beds, and the profit to the hospital system would be almost $650,000 per year.
So there is no incentive to continue to make “surgical errors.”
But it makes a better story, and you get more clicks, if you focus on the evil that hospitals and doctors are supposedly plotting.
Skeptical Scalpel is a retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and critical care and has re-certified in both several times. He blogs at SkepticalScalpel.blogspot.com and tweets as @SkepticScalpel. His blog averages over 1400 page views per day, and he has over 8800 followers on Twitter.