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Caution urged as surgeons' death rates published



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Published Date: 08 October 2008
By Lyndsay Moss
PATIENTS undergoing surgery in Scotland will be able to see the death rate for the surgeon treating them after new figures were published yesterday.
The statistics run from 2004 to 2007, but experts said the "crude" data came with a "health warning" as it did not consider the types of operations being carried out or the severity of patients' illness.

ISD (Information Services Division) Scotla
nd, which publishes health statistics on a range of issues, released updated figures of surgical mortality rates after first publishing data in 2006.

The statistics showed that the majority of deaths occurred in patients treated as emergencies, rather than planned surgery.

Many surgeons had a zero mortality rate, mostly in specialities such as eye and plastic surgery where risks are generally lower. In comparison, heart surgeons dealing with very ill and complex conditions had higher rates.

Dr Penny Bridger, consultant in public health medicine at ISD, urged caution over the figures.

"Essentially, this data is extremely crude and takes no account of the case-mix of the patients involved, such as how ill they are, whether they are elderly and how they have been treated," she said.

"It does not give any information on how they were when admitted and if they were extremely sick."

She added: "It is not fair to say a surgeon has the highest mortality rate based on these figures, as they do not compare like with like. We have to be very, very careful when small numbers of patients are involved as this can influence the mortality rate."

John Orr, president of the Royal College of Surgeons of Edinburgh, said it had no problems with the data being released, so long as it was correctly interpreted.

"Some surgeons may have a high rate because they take on high-risk cases," he said.

"We will look at this data to interpret it in more detail. But from what I have seen, there is nothing that sticks out as being of concern."

The British Medical Association Scotland also said it was happy for patients to access the data, so long as they were aware of its limitations.





The full article contains 361 words and appears in The Scotsman newspaper.
Page 1 of 1

  • Last Updated: 07 October 2008 9:38 PM
  • Source: The Scotsman
  • Location: Edinburgh
 
1

Voldemort,

Edinburgh 08/10/2008 00:28:43
I'd still rather have surgeons there than not!

It is a sign of the terrible litigious society when we can sue the good samaritan for trying to help ...

The very nature of surgery carries risk and if we are not prepared to live with human error in this field then we may as well stay at home and not go to hospital.
2

james 1st,

hamilton nz 08/10/2008 02:28:27
this could have a very negative effect if it stops surgeons being willing to carry out operations where the prognosis for the patient is not good. it is also likely to cause patients anguish as they face an operation from a surgeon with perheps a higher than average mortality rate without the knowledge of perhaps how many of the operations carried out startedwith a poor prognosis.
in reality a damned stupid idea
3

MarkInAlpine,

Alpine, Texas 08/10/2008 02:34:06
My father was a surgeon. My uncle, his younger brother, was a pathologist. Care to guess which one never had a patient die on him?
4

Guga II,

Rockall 08/10/2008 04:19:43
Publishing these statistics is not such a bad idea, as long as you compare like with like, i.e. if eye surgeons are compared with eye surgeons, heart surgeons with heart surgeons and so on; and not forgetting GPs.

If one heart surgeon, for example, loses 90% of his patients, but the average loss amongst heart surgeons is 20%, then there may be good reason for a close look at the one with the higher losses.

However, I would have assumed that they already did that sort of thing, i.e. comparison of death rates amongst doctors, especially after the efforts of that GP, Harold Shipman, who was killing off his elderly patients; possibly by the hundreds.

5

tomi,

08/10/2008 04:53:34
The death rate of the patients have no necessary corrilation with the competency of the surgeon.

Even the very best surgeons can have their patients die.

This is a very vague and unreliable statistic.
6

!Ya basta!,

08/10/2008 07:22:33
If we are to move towards more evidence based medicine it is absolutely essential to collect and analyse this kind of data. Over time, the data definitions will improve to account for different variables. Comparisons with international norms should also be encouraged.

The critical issue is how the data is used and I agree that caution should be taken. Two elements seem important.

If a particular surgeon or hospital is showing outlying results, a more detailed investigation should be launched to ensure best practice is being followed. Unless the surgeon/hospital is being negligent or not following minimum standards, and which therefore requires disciplinary action, a program of improvement should be introduced. That is, the stats are used as a learning and practice improvement tool.

The second issue is about independent review of results. Like all professions, self policing does not work. An independent review body is required.

This approach would seem to me to be most likely to result in improved practices and reduce the likelihood of either witch hunts or cover ups.

PS To protect surgeons and to encourage performance improvement, maybe data should be anonymised as far as the public is concerned but available to individual surgeons (and the review body and employing health Trust obviously) so they can compare their performance with the average.
7

drunken proffet,

Tassy 08/10/2008 08:03:11
Who thought this idea up? ISD sounds very like a Quango that has been infiltrated by the intellectually challenged. As they say about statistics, lies, lies and damned lies. Who am I to disagree. Leave the assessment of surgeons to the medical profession. They have a history in Scotland of honesty, integrity and being right. If the ISD are really interested in keeping their jobs, how about a study of the legal profession?
8

Vincent-W,

08/10/2008 08:24:39
Guga,

You will not be surprised that I disagree with you. Data of this sort is extremely dangerous in the wrong hands.

I have a decent working knowledge of statistics and I can see straight away that most expert and innovative surgeons will routinely work on the most 'risky' cases and will suffer the highest casualty rates whereas the newest surgeons will tend to work on less extreme cases.

It only needs one journo to write a poorly written 'story' and there could be major problems for our most expert and skilled surgeons. Journalists are notoriously ignorant of scientific, statistical aand mathematical information. This is RAW data.
9

TimW1234,

Ottawa, Canada 08/10/2008 10:27:28
Isn't it nice to know which surgeon may kill you on the operating table?

Thanks, but no thanks.

I would rather die in ignorance without the added stress of knowing which surgeons have high rates of opeating room deaths - even if the situation and condition of the patient was dire and ultimately pre-ordained.
10

Guga II,

Rockall 08/10/2008 11:54:12
#8 Vincent-W.

This is all very well, but if they had had such statistics and/or paid any attention to them, then Shipman would not have been able to murder as many people as he did.
11

ENT doc,

Dumfries 08/10/2008 14:28:39
Dr Shipman is completely irrelevant to this thread; this is about surgical mortality. As Vincent-W says, the surgeon who is willing to operate on the patients that everyone else has turned down may have a high mortality rate, but to look at it from the other direction - some of his patients survive, without his attempt they would ALL have died.
12

Peter Venkman PhD,

NYC 08/10/2008 14:53:17
#7 drunken proffet

You asked who thought this up. Funnily enough, it was the journos at the esteemed publication you are now reading. The Scottish Information Commissioner ordered the release of this information in 2005 following an appeal by The Scotsman, despite concerns over how the could be misinterpreted.
13

,

08/10/2008 15:35:38
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