Americans comparison-shop for everything. Almost everything, that is.
People scrutinize product reviews before making even minor Amazon purchases. They research restaurants based on Google and Yelp ratings. They spend hours meticulously investigating the merits of different hotels and cruise ships.
But when the time comes to choose a surgeon for a major procedure — a decision far more consequential than any online purchase, dinner reservation, or vacation itinerary — most Americans don’t realize they can, and should, shop around.
Instead, they rely on referrals from primary care physicians or recommendations from friends and family. Those referrals are well-intentioned, but they are not always grounded in objective performance metrics.
That’s a problem. Research consistently shows that outcomes for the same procedure vary widely from one hospital to another, and even from one surgeon to another within the same hospital network. Patients deserve access to this data, so they can choose the best care.
A landmark New England Journal of Medicine study found that patients undergoing certain high-risk procedures at hospitals that only occasionally hosted those operations faced substantially higher mortality rates than those treated at high-volume centers, with differences in rates reaching 12% for some operations. Another study found that patients undergoing joint replacements had roughly 33% higher odds of complications when the procedure was performed at low-volume hospitals rather than high-volume hospitals.
The variation doesn’t stop at the hospital level. It exists between surgeons, too.
“Practice makes perfect” is a truism in sports — and in medicine too. In orthopedics, the benefits of an experienced surgeon are most evident after patients leave the operating room: fewer complications, fewer infections, fewer revision procedures, and smoother recoveries. A recent analysis of 12 studies found that patients who underwent shoulder surgery with surgeons who perform the procedure frequently had lower rates of repeat operations and hospital readmissions.
Technical skill alone has been shown to account for more than a quarter of the variation in complication rates among surgeons performing the same procedure.
Despite the life-altering consequences, most patients never seek out this data. Many don’t even realize it exists.
That pains me. As an orthopedic surgeon, I welcome questions and value open dialogue with my patients. Most of my colleagues do as well.
Here are three questions every patient should ask before a major surgical procedure:
1. How many times have you performed this procedure in the past year? Volume matters. Ask about complication and infection rates, and how often patients require readmission or revision surgery. Every surgery carries risk — but those risks are not identical everywhere.
2. How do your outcomes compare to national benchmarks? Surgeons engaged in research and quality review should be able to answer this. If they cannot, that is itself informative.
3. How are you staying current on best practices? Medicine evolves rapidly. New techniques, implant designs, infection-prevention strategies, and recovery protocols emerge continually. Surgeons who participate in research, teach, and attend specialty conferences are more immersed in ongoing performance review and improvement.
Studies examining newly adopted procedures show why this matters. In one analysis of a new colonoscopy technique, complication rates varied almost twofold between physicians — a far greater variation than seen with the traditional colonoscopy technique.
When feasible, patients should consider academic medical centers, which tend to prioritize data tracking, peer review, and continuous quality improvement. While excellent surgeons practice outside academic centers as well, these environments are more likely to measure outcomes rigorously and integrate new research into practice quickly and systematically.
The burden, however, should not rest solely on patients to uncover this information one question at a time. Hospitals and health systems should publish data on complication rates, readmissions, revision surgeries, and patient-reported recovery metrics. Just as consumers can compare car crash-test ratings, patients should be able to review standardized, side-by-side surgical performance data before making life-altering decisions.
Greater transparency would also strengthen the healthcare system as a whole. Public reporting drives improvement. Reducing preventable complications spares patients unnecessary suffering and lowers costs for families, employers, and insurers alike.
Americans commonly check restaurant reviews and ratings to make sure they don’t get a bad meal. It should be just as common for patients to compare their physicians and hospitals before undergoing a major procedure. And it’s up to the healthcare system to start proactively providing that evidence. Patients deserve nothing less.
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