The Case for Transparency in Surgery

Why knowing your surgeon’s track record can save health, money, and peace of mind

Surgery outcomes are not the same everywhere—or with every surgeon. Studies show wide differences in complication rates and recovery between surgeons and hospitals, even for the same operation on similar patients. Higher-skill and higher-experience (higher-volume) surgeons tend to have fewer complications and deaths; a few hours with the right surgeon can change the next few months—or years—of your life. Making these differences visible to patients and families (what we call transparency) improves safety, trust, and value. (New England Journal of Medicine)

Today, some useful information exists (for example, Medicare’s Care Compare site and independent hospital safety grades), but surgeon-level data are still hard to find, inconsistent, or missing entirely. Stronger transparency—clear, comparable information about a surgeon’s experience and outcomes—can help people  make better choices, support shared decision-making with physicians, and reduce unnecessary or risky surgery. (Medicare)

In the following sections we’ll look at this in more detail, and describe how the Procendi outcomes search engine solves this problem.

 

1.     What “transparency” means—and why it matters

Transparency in medical care means openly sharing how doctors and hospitals perform: their experience with specific procedures, complication and readmission rates, and patient experience—presented in ways regular people can understand. When healthcare organizations are transparent, it builds trust, encourages improvement, and helps families choose quality care. Evidence shows transparency can drive provider accountability and patient safety. (PMC)

2.     The problem: outcomes vary—often by a lot

Two truths from modern surgical research:

  • Skill matters. In a landmark New England Journal of Medicine study, peer surgeons watched videos of practicing bariatric surgeons and rated technical skill. Patients treated by the highest-rated surgeons had far lower complication, reoperation, readmission, and death rates than those treated by the lowest-rated surgeons. In plain terms: better technical skill translated into better recoveries. (New England Journal of Medicine)
  • Experience matters. Large evidence reviews show that, for many operations, surgeons and hospitals that do more of a given procedure (higher volume) have fewer major complications and deaths. Volume isn’t everything—but it’s a strong, consistent signal that’s easy to understand. (PMC)
  • Variation is real—even under the same brand. A national study of hospitals affiliated with top-ranked health systems found large gaps in risk-adjusted surgical results across sister hospitals, sometimes 4-fold differences in complications and deaths—showing that a prestigious name doesn’t guarantee consistent outcomes across locations. (JAMA Network)
  • Not all high-volume surgeons are equal. Most high-volume surgeons have better results, but there are exceptions—underscoring why outcomes (not just volume) should be visible. (PubMed)
  • Complications are common and costly. Careful prospective tracking finds surgical complication rates higher than many people realize; a substantial share of serious adverse events are considered preventable. Reducing complications meaningfully improves survival and recovery. (JAMA Network)

3.     The hidden costs of low transparency

  • Unnecessary surgery and overtreatment. Physicians themselves estimate that about 1 in 5 medical services are unnecessary; investigative reviews and claims analyses continue to identify large pockets of low-value procedures (for example, some spine surgeries). Transparent, procedure-specific outcomes and appropriateness data help patients avoid care they don’t need. (PMC)
  • Financial harm and confusion. Patients often overestimate what surgery will cost, while surgeons underestimate it; without clear quality and cost information, families struggle to plan and may pick options that are riskier and more expensive. (ScienceDirect)
  • Uneven maternity and surgical care. For example, C-section rates vary dramatically by hospital. Where you go can be a stronger predictor than your personal risk—yet in many states those hospital-level rates are hard for patients to see. Transparency has helped some places, like California, drive rates down by making data public. (Business Insider)

4.     What useful transparency looks like

A practical transparency “starter set” for patients and families:

  1. Surgeon experience with your procedure (e.g., how many in the last 12–24 months).
  2. Risk-adjusted outcomes: complications, unplanned returns to surgery, emergency visits, readmissions, and 30–90-day mortality for your procedure.
  3. Patient mix and case complexity (so results are fairly compared).
  4. Hospital safety record (infection prevention, medication safety, ICU staffing, and “failure-to-rescue”—how well teams prevent deaths after complications).
  5. Costs you’re likely to face for the surgery and the 90-day recovery window. (IHPI)

Where can you see some of this today?

  • Medicare Care Compare shows hospital-level quality and some clinician information, with CMS expanding procedure details to help patients identify experienced clinicians for common procedures. Independent groups (e.g., Leapfrog) publish hospital safety grades. Surgeon-level, procedure-specific outcomes remain limited or scattered, which is why additional transparency efforts are so important. (Medicare)

5.     How transparency helps people

  • Safer choices. If you’re considering gallbladder, hernia, prostate, joint, or women’s health surgery, choosing a surgeon with strong outcomes and adequate recent volume reduces your odds of complications and speeds recovery. Compare it to choosing a pilot who has flown your route many times—plus proof that their passengers land safely. (PMC)
  • Better conversations. Clear data supports shared decision-making—a structured discussion of options, benefits, and risks—shown to improve decision quality and reduce regret. It helps you ask targeted questions (“How do your results compare for patients like me?”) and align care with your goals. (PMC)
  • Lower total cost of care. Avoiding complications and unnecessary procedures saves money (yours and the system’s) and reduces time away from home and work. Health policy analyses attribute a meaningful share of excess U.S. spending to low-value or avoidable care—transparency is a direct countermeasure. (Health Affairs)

6.     A simple checklist to use before scheduling surgery

Bring this to your next visit:

  1. Experience: How many of this exact procedure have you performed in the past year? Past two years? How many at this hospital? (BioMed Central)
  2. Outcomes: What are your rates of major complications, reoperations, ER visits, and readmissions within 30–90 days—for patients like me? How do they compare regionally? (New England Journal of Medicine)
  3. Team and setting: Who is on the anesthesia and nursing team? What is this hospital’s safety grade and “failure-to-rescue” performance? (IHPI)
  4. Alternatives: Are there effective non-surgical options? What happens if I wait? (This guards against unnecessary surgery.) (PMC)
  5. Costs: What are my expected out-of-pocket costs for surgery and 90-day recovery? (Ask your insurer, too.) (ScienceDirect)

7.     Policy steps that would help

  • Standardize surgeon-level reporting for common procedures: recent case counts and risk-adjusted 30–90-day outcomes, displayed in plain language, with fair risk adjustment to avoid penalizing those who treat sicker patients. (Centers for Medicare & Medicaid Services)
  • Strengthen and align public platforms (e.g., Medicare Care Compare) so patients don’t have to hunt across multiple sites, and include measures patients care about most (pain control, return to normal activity, financial impact). (Centers for Medicare & Medicaid Services)
  • Support improvement collaboratives that pair transparency with coaching (video review, peer feedback) shown to lift technical skill and outcomes. (New England Journal of Medicine)

8.     Common concerns—answered

“Won’t surgeons avoid high-risk patients?”
Fair risk adjustment and peer-reviewed metrics minimize this risk. In fact, internal feedback programs tied to transparent benchmarking have helped surgeons improve without encouraging “cherry-picking.” (WIRED)

“Is volume just a proxy?”
Volume is a useful starting signal, but not sufficient. Some high-volume surgeons still have average results—hence the need to publish actual outcomes alongside experience. (PubMed)

“Do outcomes really differ that much across hospitals?”
Yes. Even within top-ranked systems, risk-adjusted complication and death rates can vary several-fold, and differences in “rescue after a complication” drive mortality. Transparency helps patients spot safer settings. (JAMA Network)

9.     Bottom line for families

If you’re  and facing surgery, ask for the facts. Choose a surgeon and hospital that can show strong, recent, procedure-specific results and a plan to prevent and promptly manage complications. That’s transparency at work—and it’s one of the simplest, most powerful ways to protect your health and finances. (New England Journal of Medicine)

Quick glossary

  • Complication: An unplanned medical problem after surgery (e.g., infection or bleeding).
  • Readmission: Returning to the hospital within 30–90 days after discharge.
  • Risk adjustment: A method that accounts for patient age and health conditions so comparisons between surgeons are fair.
  • Failure-to-rescue: When a hospital does not prevent death after a complication has already occurred.

Sources (select)

  • Birkmeyer JD, et al. Surgical Skill and Complication Rates after Bariatric Surgery. NEJM (2013). Strong link between technical skill and outcomes. (New England Journal of Medicine)
  • Morche J, et al. Surgeon volume and outcomes. Systematic review showing fewer complications with higher surgeon volume. (PMC)
  • Levaillant M, et al. Hospital volume–outcome relationship in surgery. BMC Med Res Methodol (2021). Volume relates to mortality/complications in most studies. (BioMed Central)
  • Sheetz KH, et al. Variation in Surgical Outcomes Across Networks of Honor Roll Hospitals. JAMA Surgery (2019). Large within-network variation. (JAMA Network)
  • CMS Care Compare and Doctors & Clinicians Initiative. Public reporting of hospital performance and initial clinician procedure info. (Centers for Medicare & Medicaid Services)
  • Leapfrog Group. Hospital Safety Grades and reports. Independent hospital safety ratings. (Leapfrog)
  • Healey MA, et al. Complications in Surgical Patients. JAMA Surgery (2002). Higher-than-expected complication rates; many preventable. (JAMA Network)
  • Lyu H, et al. Overtreatment in the United States. PLOS One (2017). Physician estimates of unnecessary care. (PMC)
  • Health Affairs brief on clinical waste and excess spending. (Health Affairs)
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