Who are the Triangle’s best surgeons? New data provides scores and rankings.

The Triangle, long known as a hub for world-class health care, is home to three surgeons who rank in the top 1 percent of doctors in their surgical specialty, according to data released to The News & Observer.

One of the region’s top-ranked surgeons, Bradley Vaughn, is a knee and hip specialist who received a perfect score of 800 for hundreds of hip operations he performed on Medicare patients over a four-year period. Vaughn, who operates at UNC Rex Hospital in Raleigh, is one of just 31 surgeons in the country to receive a perfect score from Seattle-based technology firm Mpirica.

Another area surgeon, Michael Haglund, is the nation’s top-rated surgeon for three spinal fusion procedures, according to the data analysis conducted by Mpirica. Haglund, who received the nation’s highest score of 720 in the three procedures, is also a professor of neurosurgery at Duke University’s School of Medicine.

Mpirica is a 3 1/2-year-old company that specializes in analyzing the performance of hospitals and surgeons and selling its analyses to employee benefits consultants, self-insured employers and Medicare Advantage health insurers. The company provided Triangle surgeon rankings to The News & Observer upon request, releasing data on doctors who scored in the “excellent” range, between 600 points and 800 points on Mpirica’s scale.

The Mpirica ratings largely line up with the professional reputations of surgeons, according to the trio of nationally top-rated surgeons interviewed by The N&O: Vaughn, Haglund and Duke University orthopedics professor Scott Kelley, a hip and knee surgeon. They said the other doctors with excellent Mpirica scores are the ones they would select for surgery for themselves and for their families.

These doctors said they would typically select a surgeon by talking to nurses, scrub techs, anesthesiologists and other medical professionals about the reputations of surgeons they work with. They would ask who is the most experienced and the fastest, and has the fewest complications.

“Some of the biggest information loops are what the nurses are saying,” said Vaughn, who scored 630 for knee operations. “The data is starting to show stuff that we’ve always known.”

The doctors also said they know which surgeons have high rates of infections, blood clots, implant malfunctions and other complications.

“We see each others’ complications,” Kelley said. “You named a bunch of doctors who I almost never see complications from.”

Mpirica makes its data on surgeons available to the public in reports customized by specialty and region, and sold online for $49. But the data is not not widely publicized because the 19-employee start-up does not have a sufficient marketing budget, said CEO Shakil Haroon.

Mpirica’s surgeon ratings cover more doctors and surgical categories than the sampling provided to The N&O. Mpirca scored 106 Triangle surgeons for The N&O in seven surgical categories. The N&O is highlighting those rated excellent.

Mpirica ranks surgeons in 28 categories overall. The company provided The N&O with names and scores for “excellent” surgeons only in the most complicated, costly and common procedures: knee replacements, hip replacements, angioplasties, spinal fusions, coronary bypasses and gallbladder removals. Other surgical categories Mpirica assesses include breast removal, carotid artery surgery, colorectal surgery and cataract removal.

Mpirica’s methodology assesses the quality of hospitals and surgeons in several performance categories: death during the procedure, significant complications during the hospital stay, readmission to the hospital, and emergency department visits and death related to the procedure after the patient is discharged from the hospital.

Because most procedures are highly unlikely to result in death, Mpirica’s performance scores are based largely on the length of time a patient stays in the hospital after the operation, as well as on readmissions. Mpirica uses the length of the hospital stay as a proxy for severe complications from the procedure.

Mpirica does not provide the raw data that is factored into a surgeon’s score, but Vaughn said the average length of hospital stay for his patients is 1.8 days. He said that is well below the typical patient’s hospital stay of two to three days for a knee replacement and a hip replacement.

Mpirica advises patients not to rely exclusively on its scoring system and to consult with their doctors on important medical decisions. Not every surgeon receives a score, because doctors who don’t treat Medicare patients in sufficient volume don’t show up in Mpirica’s ranking system. And the company stresses that its scores are interpretations of historical Medicare claims data, not predictions of future results.

What’s more, Mpirica doesn’t measure everything a patient might want to know. For example, its rankings don’t weigh bedside manner, patient surveys and other subjective information. Most importantly, Mpirica does not take into account disciplinary matters, such as malpractice settlements or medical board investigations. The N&O checked every “excellent” surgeon Mpirica provided and is listing here the 50 surgeons who had no more than one malpractice settlement and no disciplinary action by the NC Medical Board.

Still, Mpirica’s methodology can reveal quality doctors who might be overlooked by patients who rely on the gold-plated reputations of prestigious health care networks, like Duke University Health System and UNC Health Care, as their guide to quality. For example: One of the Triangle’s top three surgeons for gallbladder removal, James Collins III, is affiliated with Johnston Health and performs surgeries in Clayton and Smithfield.

This story was originally published September 22, 2017 at 4:00 PM with the headline "Who are the Triangle’s best surgeons? New data provides scores and rankings.."