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It wasn’t just an educated guess: Dr. Bussell used a new risk calculator that handicaps an individual patient’s chances of surgical complications based on personal medical history and physical condition. It also helps doctors and patients make tough decisions about procedures.

For Ms. Rivard, who is 67 years old, factors including her age, blood pressure and weight lifted her risks—though the surgeon was able to reassure her that they weren’t out of line, and that any complication would be manageable.

Risk calculators, used by heart surgeons for several years, are now being developed for other surgical specialties. The American College of Surgeons recently introduced calculators for surgery of the colon and pancreas, and is designing similar tools for 18 other procedures, including gastric bypass, hernia repair and prostate surgery. The calculators use data from more than one million patient records gathered as part of the group’s National Surgical Quality Improvement Program, which works with hospitals to reduce surgical errors and complications.

More than 30 million operations are performed in the U.S. annually to remove deadly cancers, repair diseased organs and replace worn-out joints. Yet going under the knife can be risky, leading to serious infections, blood clots, heart attacks and pneumonia. Those risks increase with age and for patients who are obese, smoke, abuse alcohol or have medical conditions such as diabetes and hypertension.

The nonprofit Institute for Healthcare Improvement, which works with hospitals to improve the quality of care, estimates that 2.5 million to 3.5 million surgical patients each year experience unintended harm resulting from or contributed to by surgical care. While some complications are unavoidable, surgical teams often make mistakes, such as leaving a surgical sponge in a patient, or fail to take steps known to prevent complications, such as delivering antibiotics to a patient within one hour before beginning surgery, which can dramatically cut infection rates.

Complications are also costly. The Centers for Disease Control and Prevention estimates that there are more than 290,000 surgical-site infections each year, and the cost to treat them ranges from about $12,000 to nearly $35,000 per patient—or as much as $10 billion annually.

The American College of Surgeons’ quality-improvement program is one of several efforts to help reduce such risks. It was adapted from a program originally used by the Veterans Health Administration and shown to reduce deaths at VA hospitals from surgery by 27% and complications by 45%.

Since its launch in non-VA hospitals in 2005, 250 hospitals have signed on. The program costs hospitals about $35,000 annually to participate. But a study published last September in the Annals of Surgery found that it helped 118 hospitals prevent from 262 to 524 complications per year, saving each an average of $3 million.

Preventing Complications

“If these results were translated across all U.S. hospitals, we would have the potential to prevent millions of complications a year, save potentially billions of dollars a year and provide evidence to health-care reformers that higher-quality care can cost less,” says Clifford Ko, a colorectal surgeon at the University of California, Los Angeles, and director of research and optimal patient care for the American College of Surgeons.

The calculators allow surgeons to enter a patient’s risk variables and in a matter of minutes receive a customized report outlining the risk of death and specific complications. For example, using data from 28,863 patients who underwent colorectal surgery at 182 hospitals from 2006 to 2007, the colorectal risk calculator has 15 variables to help predict complications and death within 30 days of surgery, including age, body mass index, the extent of disease—whether it is cancer or a digestive disease—and how much of the colon must be removed.

David Bentrem, a surgeon at Northwestern University’s cancer center who has used the colorectal surgery calculator, says it not only helps assess whether a patient is a good candidate for surgery, but also helps him make sure patients understand what they are getting into—the process known as “informed consent.”

Patients often don’t read or understand the documents they sign prior to surgery, studies show, and after meeting with a surgeon they may be anxious and confused, making it hard to process and remember information key to deciding whether to go ahead with surgery or not.

“The more information we can offer surgeons to give their patients that are specific to their own individual case, the better,” says Dr. Ko. If the surgery isn’t urgently needed, Dr. Ko says he may delay it until a patient loses weight or stops smoking to lessen the risks. Patients may also decide to delay surgery after learning of the risks.

Patients considering any kind of surgery should ask if their hospital participates in surgical-quality improvement programs, and whether risk calculators are available. For example, the Society of Thoracic Surgeons offers heart surgeons a calculator to predict the risk of death and complications from heart-bypass and other cardiac surgeries.

While generally surgical risk calculators are not designed for use by consumers, patients can visit euroscore.org to calculate their risks for cardiac surgery, using a free program from the European System for Cardiac Operative Risk Evaluation, widely used in European hospitals.

Hospitals in the American College of Surgery quality-improvement program can also compare their performance against a national benchmark, and tell patients whether their complication rates are lower than the national average.

‘An Easy Recovery’

At Danbury Hospital, Dr. Bussell was also able to reassure Ms. Rivard that the facility has among the lowest infection rates among hospitals in the American College of Surgery’s quality-improvement program, and because her results were comparable to the average low-risk patient, he expected her procedure to be “uneventful and dull” with “an easy recovery.”

“Telling a patient there is a risk of dying from a cancer surgery is not an easy conversation to have,” says Pierre Saldinger, a surgeon who oversees the quality-improvement program at Danbury Hospital and was also in the room when Ms. Rivard heard about her surgical risks. “The calculator is a tool you need to use in a judicious way, so as not to scare the patients, but to make them feel more comfortable that you are being honest and open with them.”

Ms. Rivard says she had already determined that she needed the surgery before learning of the risks, but she and her two daughters, who accompanied her to the consultation, wanted to hear the doctor put the calculator data in perspective.

The last time she had surgery—on her hip, nine years ago—no one discussed risks with her. While hearing about the risks of complications and infections was “a little overwhelming,” she says, “I want to know everything that might happen.”

Write to Laura Landro at informedpatient@wsj.com

You may recognize the quote from which the title of this blog was irreverently taken. Most people would incorrectly identify the quote from “The Treasure of the Sierra Madre” (actually used in “Blazing Saddles”), just as the federal government and many states incorrectly believe they don’t need a balanced budget. This is especially true in the bad times when many haughtily believe government spending is the answer to fiscal woes.

California is perhaps the poster child for this type of thinking. They increased spending even though they couldn’t support their current budget and then acted surprised they have to cut the budget! Fortunately, Missouri has a constitutional requirement that a balanced budget must be signed and maintained by the Governor.

Occasionally, despite the best estimates and efforts of the Governor and legislature, the budget is not sustainable given the revenue collections. So, what happens when revenues fail to match spending? Tough choices have to be made and under the state constitution, those choices are left to the Governor to maintain a balanced budget. Three main areas present themselves for reductions; education (principally higher education), hiring freezes and Medicaid reimbursements.

Higher education has the target on its back because it represents approximately $1 billion in spending that is not mandated by constitution or state law. The Missouri constitution does require the state to provide some level of funding to higher education. But unlike elementary and secondary education, the constitution does not mandate a level of spending.

Hiring freezes are somewhat painless and are most readily acceptable to the general public as most of them believe there are too many government employees anyway. There are usually exceptions made for “critical” positions but a significant number of positions can go unfilled. After years of growing the number of state employees, that trend has reversed in the last 4 to 5 years.

Medicaid reimbursements are the trickiest reductions to make. Few Governors want to be known as the one who cut Medicaid recipients. Governor Blunt took appropriate action a few years ago to reduce eligibility and fraud in the Medicaid system and it saved the system for the neediest in the state.

Other Governors have chosen to reduce reimbursement rates for Medicaid providers. After all, if anyone can absorb cuts, it is the “rich” doctors. Unfortunately, “rich” doctors don’t usually accept Medicaid patients. Medicaid providers have payrolls and families to support. Reductions in reimbursement rates leave those providing Medicaid service with the decision of losing even more money, Medicaid reimbursement generally fall short of the cost of the services delivered, or simply closing their practice to any new Medicaid patients. This has the same effect as reducing eligibility.

Budget reductions are never pleasant. They may not be entirely avoidable but they can be reduced by not making unwise spending decisions during the “good times” such as was done in the 1990’s. Spending limitations that allow for reasonable government growth and for putting aside savings for the bad times would be prudent but are not popular with most politicians. Bad times are inevitable. After all they don’t call it a business cycle for nothing!

Q. Are ASCs subject to regulation?

A. Yes, ASCs are some of the most highly regulated health care providers in the country. Medicare has certified 85 percent of the centers. All states except one require ASCs to be licensed. The Missouri Dept. of Health specifies the criteria that Missouri ASCs must meet for licensure. Both the state and Medicare survery ASCs regularly to verify that the established standards are being met. In addition to state and federal inspections, nearly all surgery centers choose to complete a voluntary accreditation process conducted by their peers. ASCs that want to demonstrate a commitment to quality can see accreditation from one of four accrediting bodies. All four are recognizd by Medicare for their rigorous adherence to the highest standards of quality care. All accredited ASCs must meet specific standards that are evaluated during on-site inspections. As a result, patients visiting accredited ASCs can be assured that the centers provide the highest quality care.

Q. Does the federal government sanction ASCs?

A. Yes. Since 1982, when Medicare agreed to pay for surgeries performed in ASCs, the program has saved a significant amount of money. ASCs that receive Medicare payments must meet the programs certification criteria and receive payments only for those procedures that have been approved by Medicare. Today, more than 2,400 ASC procedures have been granted that approval. The Office of Inspector General commented in its 1999 final rule regarding safe harbor provisions that “ASCs can signficantly reduce costs for Federal health care programs, while simultaneously benefiting patients.” CMS has promoted the use of ASCs as cost-effective alternatives to higher cost settings, such as hospital inpatient surgery.

Q. How long have ASCs been in existence?

A. The first ASC opened in 1970. Today, more than 7 million surgeries are performed each year in the more than 3,300 surgery centers across the United States.

Q. What are Ambulatory Surgery Centers?

A. ASCs are facilities were surgeries that do not require hospital admission are performed. They provide a cost-effective and convenient environment that may be less stressful than what many hospitals offer. Particular ASCs may perform surgeries in a variety of specialties or dedicate their services to one specialty, such as eye care. Patients who elect to have surgery in an ASC arrive on the day of the procedure, have the surgery in an operating room, recover under the care of the nursing staff, and go home the same day, all without a hospital admission.