Secondary Logo

Institutional members access full text with Ovid®

Variation in Patient-reported Outcomes Across Hospitals Following Surgery

Waljee, Jennifer F. MD, MS*; Ghaferi, Amir MD, MS*; Finks, Jonathan F. MD*; Cassidy, Ruth MS; Varban, Oliver MD*; Carlin, Arthur MD; Carlozzi, Noelle PhD§; Dimick, Justin MD, MPH*

doi: 10.1097/MLR.0000000000000425
Original Articles

Background: Although there is growing interest in applying patient-reported outcomes (PROs) toward surgical quality, the extent to which PROs vary across hospitals following surgical procedures is unknown.

Objectives: We examined variation in PROs, specifically health-related quality of life (HRQOL), across hospitals performing bariatric surgery.

Research Design: A retrospective cohort study.

Subjects: The Michigan Bariatric Surgery Collaborative is a statewide consortium of 39 hospitals performing laparoscopic gastric bypass, gastric banding, or sleeve gastrectomy (n=11,420 patients between 2008 and 2012).

Measures: We examined generic and disease-specific HRQOL measured by the Health and Activities Limitations Index (HALex) and Bariatric Quality of Life index (BQL) preoperatively and at 1 year. We measured the variation in postoperative HRQOL across hospitals, and the effect of risk and reliability adjustment on hospital ranking.

Results: In this cohort, HRQOL varied by 56% (HALex) and 37% (BQL) across hospitals. Patient factors accounted for 58% (HALex) to 71% (BQL) of the variation in HRQOL across hospitals. After risk and reliability adjustment, HRQOL varied by 18% (by HALex) and 14.5% (by BQL) across hospitals, and the proportion of patients who experienced a large improvement in HRQOL by HALex ranged from 33% to 69% and 67% to 92% by BQL. After adjusting for patient factors and reliability, these differences diminished to 55%–64% (HALex) and 79%–84% (BQL).

Conclusions: Patient factors explain a large proportion of hospital-level variation in PROs following bariatric surgery, underscoring the importance of risk adjustment. However, some variation in PROs across hospitals remains unexplained, suggesting PROs may represent a viable indicator of hospital performance.

Supplemental Digital Content is available in the text.

*Department of Surgery, Center for Health Outcomes and Policy

Michigan Bariatric Surgery Collaborative, Center for Health Outcomes and Policy, University of Michigan, Ann Arbor

Department of Surgery, Division of General Surgery, Henry Ford Health System, Wayne State University School of Medicine, Detroit

§Department of Physical Medicine & Rehabilitation, Center for Clinical Outcomes Development and Application, University of Michigan, Ann Arbor, MI

Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website,

Supported by a Mentored Clinical Investigator Award to J.F.W. through the Agency for Healthcare Research and Quality (1K08HS023313-01).

The authors declare no conflict of interest.

Reprints: Jennifer F. Waljee, MD, MS, Section of Plastic Surgery, University of Michigan Health System, 2130 Taubman Center, SPC 5340, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-5340. E-mail:

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.