Abstract
OBJECTIVE: To determine whether ratings are associated with postoperative outcomes. BACKGROUND: Online ratings by patients or inclusion on lists of exceptional physicians are publicly available. METHODS: In this retrospective study, Medicare fee-for-service beneficiaries 65 to 99 years old undergoing one of 14 major (elective/emergent) surgeries in the United States between 2016 and 2019 were analyzed. Data were analyzed from September 2023 to March 2024. Using computational methods to extract surgeon ratings from the three highest-volume publicly available patient-initiated and peer-nominated rating platforms. The exposure of interest was ratings (0-4, 4-4.49, ≥ 4.5) on patient-initiated platforms and "Top Doctor" status on the peer-nominated platform. The primary outcome was 30-day mortality. Secondary outcomes included 30-day complications, readmission, failure to rescue, and hospital length of stay. Using linear probability models, we controlled for patient, surgeon, and hospital factors to examine associations between ratings and outcomes. RESULTS: We identified 2,690,315 patients operated on by 57,008 surgeons. Patient-initiated ratings were not consistently associated with 30-day mortality but were significantly associated with lower mortality among those treated by surgeons rated 4 to 4.49 on Platform B [adjusted risk difference (ARD), -0.06 % (95% confidence interval (CI) = -0.11 to -0.01)]. Patients treated by "Top Doctor" surgeons through peer-nomination had lower 30-day mortality ARD, -0.14 % (95% CI = -0.19 to -0.09). Surgeons with higher patient-initiated ratings had lower rates of 30-day complications and readmissions, while "Top Doctors" experienced lower rates of failure to rescue. CONCLUSIONS: Patient-initiated and peer-nominated ratings were associated with complications and readmission; mortality and failure to rescue, respectively, suggesting they capture different aspects of surgical care.