Link Shown Between Unsolicited Patient Complaints, Increased Postsurgical Complications

Patients receiving surgery from a surgeon with a high number of unsolicited patient observations may be at greater risk for postoperative complications, according to research published in JAMA Surgery (published online February 15, 2017; doi:10.1001/jamasurg.2016.5703).


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Prior research has shown a strong link between high numbers of unsolicited patient observations with an increased risk for malpractice claims. However, research examining the relationship between patient observations and adverse outcomes in general has not been conducted.

William O Cooper, MD, MPH, professor of health policy and pediatrics at Vanderbilt University School of Medicine (Nashville, TN), and colleagues conducted a retrospective study to determine whether patients whose surgeons had a higher number of unsolicited patient reports in the 24 months preceding their operations faced a greater risk for complications. Using data from the National Surgical Quality Improvement Program and the Vanderbilt Patient Advocacy Reporting System, they identified 32 125 surgical patients (mean age, 55.8±15.8 years; women, n = 18 895). 

Complications arose in 10.9% of the cohort (n = 3501); 5.5% of complications (n = 1754) were surgical and 7.5% (n = 2422) were medical. Dr Cooper and colleagues observed a significant association between prior unsolicited communications and increased risk for any complications (odds ratio [OR] = 1.0063; 95% CI, 1.0004-1.0123; P = .03), any surgical complications (OR = 1.0104; 95% CI, 1.0022-1.0186; P = .01), any medical complications (OR = 1.0079; 95% CI, 1.0009-1.0148; P = .03), and hospital readmission (OR = 1.0088; 95% CI, 1.0024-1.0151; P = .007).

Multivariable analyses that controlled for patient, surgeon, and procedural characteristics still showed significantly higher increased risks in all areas for patients whose surgeons had high unsolicited complaint rates. After adjustment, the researchers found the risk for complications among patients whose surgeons were in the highest quartile of unsolicited communications was 13.9% higher than patients whose surgeons were in the lowest quartile.

“Efforts to promote patient safety and address the risk of malpractice claims should continue to focus on surgeons’ ability to communicate respectfully and effectively with patients and other medical professionals,” Dr Cooper and colleagues wrote.—Cameron Kelsall