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Triangle hospitals among nation’s best, worst, for hip replacements

Three Triangle hospitals just a short drive apart got some the nation’s highest and lowest scores for the quality of their hip replacement surgery in a new report that rates hospitals for performance and safety.

The report compares 10 of the nation’s most renowned hospitals, including Duke University Hospital, in two dozen surgical categories.

While Duke received a mix of excellent and passing grades in most areas – like breast removal, coronary bypass and knee replacement surgery – the Durham hospital got a failing grade in hip surgeries. Otherwise Duke University Hospital received strong overall performance scores, as the flagship hospital in the Duke University Health System has done on other such surveys.

The report provides local alternatives with superior service in cases where one of 10 hospitals received a poor score. In Duke’s case, the better alternatives for hip replacements are UNC Rex Healthcare and Duke Regional Hospital.

Allan Kirk, Chairman of the Department of Surgery at Duke University School of Medicine, said Duke Regional is Duke University Health System’s destination hospital for hip surgeries.

“Hip replacement is a signature program at Duke Regional Hospital, which is where the vast majority of our hip replacement patients seek care, and the outcomes for hip replacement at Duke Regional are excellent,” said Kirk, who is also surgeon-in-chief at Duke University Health System.

“Patients who receive hip replacements at Duke University Hospital typically have significant co-morbidities, and rating organizations often struggle to appropriately risk adjust for the extreme conditions we see,” Kirk said. “For example, a patient who needs a hip replacement may go to Duke Regional, while a patient who has had a heart transplant and needs a hip replacement would likely go to Duke University Hospital.”

The report was issued Monday by MPRICA, a Seattle organization founded in 2014 by software entrepreneur Shakil Haroon. MPIRICA is only the latest attempt to provide information-starved health care consumers with data about hospital safety and performance, as patients seek become more involved in health-care decisions.

For its analysis, MPRICA picked 10 of the nation’s top hospital systems to demonstrate that their performance in specific medical specialties doesn’t always match their stellar reputations. The organization used Medicare data to assign a numerical quality performance score, ranging from 100 to 800, for each hospital’s performance level.

MPIRICA said its scores are based on mortality, complications, re-admissions and ER visits within 90 days of the procedure. The scores are adjusted to account for the risk involved with more complex cases so that hospitals are not penalized for admitting sicker patients. Unlike other hospital performance surveys, MPIRICA does not look at a hospital’s track record on following protocols, contending that following procedures does not predict outcomes.

Duke University Hospital received just one poor score – in hip surgery – and was top-rated overall. Of the 10 hospital systems the organization assessed, nine had at least one “below average” score and seven had more than one poor score. Duke University ranked “excellent” in 14 surgical categories. Only three others received 14 “excellent” marks – Mayo Clinic Hospital Rochester, New York Presbyterian Hospital and UCSF Medical Center – and no hospital system ranked “excellent” in more than 14 areas.

MPIRICA gave Duke University Hospital 160 points in hip replacements, with 100 being the lowest possible score. UNC Rex in Raleigh got a 770, nearly a perfect score, and Duke Regional in Durham scored 650.

Duke lands on top in most national rankings. A healthcare report last year by U.S. News & World Reports, which looked at 5,000 medical centers, ranked Duke University as the Triangle’s best hospital. U.S. News ranked UNC Hospitals as the Triangle’s second-best, assigned third place to Rex and gave the fourth-place slot to WakeMed Health & Hospitals.

U.S. News ranked Duke No. 15 in the country for orthopedic procedures, including hip replacement. Like MPIRICA, U.S. News based it rankings on Medicare patient results. Duke received high scores on survival rates and above average at preventing complications, but “worst” in preventing re-admissions and “worst than average” in preventing infections.

Leapfrog, another hospital rating group, in April gave Duke University Hospital an “A” grade, but cited several areas in surgery where Duke University Hospital performed below average nationwide: wounds splitting open, dangerous blood clots and collapsed lungs. These assessments were not specific to hip replacements.

The Leapfrog survey also noted surgical problems at Rex, such as dangerous objects left in patients’ bodies, and accidental cuts and tears. But Rex is the only hospital in North Carolina to receive straight “A” grades since the Leapfrog Group began its national hospital safety scorecard in 2012. Last fall, Leapfrog named Rex to its list of Top Hospitals in the country – the only North Carolina hospital to receive that recognition.

John Murawski: 919-829-8932, @johnmurawski

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