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Hospitals are rapidly consolidating into regional delivery networks. Whether these multihospital networks leverage their combined assets to improve quality and provide a uniform standard of care has not been explored. So, what is the consistency of surgical quality across hospitals that are affiliated with the 2018 US News & World Report Honor Roll hospitals?

This question was asked, and likely answered in a report by researchers published this month in the JAMA Surgery.

This longitudinal analysis of 87 hospitals that participated in 1 of 16 networks that are affiliated with US News & World Report Honor Roll hospitals used data from Medicare beneficiaries who were undergoing colectomy, coronary artery bypass graft, or hip replacement. The task was to evaluate the variation in risk-adjusted surgical outcomes at Honor Roll and affiliated hospitals within and across networks.

The outcomes measured were thirty-day postoperative complications, mortality, failure to rescue, and re-admissions.

The new study shows “you shouldn’t assume that a hospital that is affiliated with a very well known medical center is able to offer the same services,” said the study’s lead author, Dr. Kyle Sheetz, a research fellow at the Center for Healthcare Outcomes and Policy at the University of Michigan in Ann Arbor. “It may, but it may not. You just can’t make that assumption.”

As it turns out, the Honor Roll hospitals didn’t always have consistently better outcomes than their network affiliates, Sheetz and colleagues found. They tended to have higher complication rates compared to affiliated hospitals: 22 percent versus 18 percent. But this may be because the Honor Roll hospitals were getting the more complicated cases, Sheetz said.

The most telling statistic the researchers gathered may have been “failure to rescue rates,” a measure of how well hospitals cope with surgical complications. To avoid “failure to rescue,” hospital staff need to recognize a complication early “and manage it and prevent the accumulation of other complications,” Sheetz explained. “So it’s ‘rescuing’ that patient.”

Honor Roll hospitals had lower failure to rescue rates than affiliated hospitals: 13 percent versus 15 percent.

Given the variability within networks, “if patients are within a bigger system, they should realize it’s okay to ask about where and by whom you would have the safest operation,” Sheetz said