Identify Surgeons

Surgeons are identified based on their specialty information in the 2023 National Downloadable NPI file and National Plan and Provider Enumeration System (NPPES) file published by the Centers for Medicare and Medicaid Services. All surgeons are included if they have one of the following primary specialties: cardiology and cardiothoracic surgery, gastroenterology, general surgery, neurosurgery, orthopedic surgery, otolaryngology (ENT), spine surgery, surgical oncology, urology, and vascular surgery.

Obtain Procedural Volumes

Medicare procedural volume comes from the 100% 2021-2022 Medicare fee-for-service inpatient and outpatient claims data.

Surgeons who performed 8 or fewer procedures for Medicare patients in total in 2021-2022 are excluded from further analysis. In addition, surgeons who graduated from a medical school within 6 years are excluded since they are likely still in a training program.

Surgical specialties are determined based on Medicare procedural volumes. A surgeon is attributed to a specialty if more than 50% of their total procedures are in that specialty. For orthopedics, subspecialties are similarly classified – including hip & knee, foot & ankle, shoulder & elbow, hand & wrist, and generalists.

Hospitals are identified based on the same Medicare claims data. To be included in the Research All-Stars a hospital has to have at least one eligible surgeon during 2021-2022. To be eligible for the overall hospital-level Research All-Stars across 10 surgical specialties, each hospital is required to have at least 30 surgeons and 5 surgical specialties represented.

Attribute Surgeons to Hospitals

Using a plurality rule, a surgeon is attributed to a hospital if the hospital:

1. has the largest number of procedures performed by the surgeon for Medicare patients; and
2. accounts for ≥30% of the surgeon’s total Medicare volume; and
3. has the most recent procedure if there is a tie

Surgeons who perform Medicare procedures in multiple hospitals without any of the hospitals meeting the 30% threshold are included in surgeon-level Research All-Stars but excluded from hospital-level Research All-Stars.

Compile Peer-Reviewed Publications by Surgeons

From the PubMed database, peer-reviewed articles published between 2021 and 2022 are imported for analysis. An article is attributed to a surgeon if the author's name and affiliation match the surgeon's information. We also make sure the publication topic is related to the surgeon's specialty for a higher matching accuracy.

Calculate Publication Weights

All publications come from PubMed. Publications are weighted using two factors: Journal Impact Factor and author position. Letters to editors are excluded from the calculation since they are not comparable to other research articles.

1. Journal Impact Factor

2. Author position

   1. Single author: 100%
   2. Two authors: 1st author = 60%; last author = 40%
   3. ≥3 authors: 1st author = 45%, last author = 30% each; other authors = 25% / (total # of authors - 2)
3. Author-specific weighted individual article score = Journal Impact Factor x Author Position Weight

Create a Weighted Publication Score

A weighted publication score is calculated for each surgeon and each hospital.

1. Surgeon weighted publication score = Sum(author-specific weighted individual article score)

2. For each surgical specialty:

   1. Hospital weighted average publication score = Sum(Surgeon weighted publication score)/(Number of attributed surgeons)

3. For all 10 surgical specialties:

   1. Normalize surgeon weighted publication scores for each surgical specialty to a 0-100 scale. This is to ensure the comparability across surgical specialties given that journal impact factors vary largely across specialties.
   2. Normalized hospital weighted average publication score = Sum(Normalized surgeon weighted publication score across all 10 specialties)/(Number of attributed surgeons in all 10 specialties)