Is using surgical death rates the best way to assess performance - The Lancet

The NHS England made public the mortality rates of 7 types of surgery for individual surgeons last week by publishing the data on the NHS Choices website  with the aim that it would provide transparency, help patients choose their surgeons and improve the quality of care.


However a study carried out by researchers at the London School of Hygiene & Tropical Medicine, published in the Lancet, said concentrating on the death rates for individual surgeons will not spot poor performance in certain fields and could lead to "false complacency".

The researchers argued that for some specialties, the number of procedures that a surgeon does annually is low, so the chance of identifying poor performance is also low. Based on the number of surgeries performed over 3 years, they found that 75% of UK heart surgeons perform sufficient procedures to give 60% power to use death rate to identify the poor peformance, 56% perfom enough procedures to give 80% power. However, for other procedures, the number of surgeons performing enough surgeries is much lower, eg for bowel resection, only 17% of surgeons perform enough of these surgeries to give 60% power to use death rate to identify the poor peformance and no surgeons perofrm enough surgeries to give 80% power.

They also noted that experienced surgeons my be more likely to operate in high- risk cases that may have much higher risk of mortality, this does not necessarily indicate poor performance of these surgeons.

The authors recommended a number of options to assess performance more reliably including pooling death data over a longer period of time, pooling death rates within specialties or per hospital. Other patient outcomes, such as post-operative bleeding, bleeding, infection, pain , further surgery or readmission could also provide better assessment of surgical performance.

Source: Walker K, Neuburger J, Groene O, et al. Public reporting of surgeon outcomes: low numbers of procedures lead to false complacency. The Lancet. Published online July 5 2013 ( f/t via Athens)