Individual mortality rates in Britain

Twenty five heart surgeons in Northwest England publish their individual mortality rates in this week's BMJ. The results show that all surgeons are performing to satisfactory standards.

This type of analysis will become increasingly common under the Freedom of Information Act, which is now law in the UK, and should help to promote a culture of openness and transparency in healthcare delivery, they say.

The Bristol Royal Infirmary inquiry into child heart surgery deaths recommended that patients must be able to see information about the relative performance of individual consultants operating within hospitals. But so far, this information has not been available for any operations in the UK, and publication of 'raw' figures has been criticised as being unfair to those surgeons who carry out the most difficult operations on the most ill patients.

The cardiac surgeons of Northwest England collected and analysed mortality data for patients undergoing two types of heart operation (coronary artery surgery or aortic valve replacement) for the first time between April 2001 and March 2004.

The data was then risk-adjusted, to take into account the complexity and severity of the patients' illness, and the figures were compared with national data.

A total of 10,163 patients had surgery under the care of 25 surgeons. The average number of patients per surgeon was 363 for coronary surgery and 44 for aortic valve surgery. The proportion of high risk surgery was 17% for coronary surgery and 50% for aortic valve surgery.

The average mortality for coronary surgery was 1.8% and for aortic valve surgery was 1.9%. All surgeons' mortality fell below the national average for both operations.

"We feel that it is essential to stratify surgeon outcomes by risk to be fair to surgeons and prevent them from taking on only the easiest and least severe cases," say the authors. "The public is now able to see the outcomes of individual surgeons and can be reassured that all are performing to satisfactory standards."

This type of analysis could stimulate improvements in systems of care, as long as it does not lead to systematic denial of surgery to higher risk patients who may benefit from an operation, they conclude.

An accompanying editorial argues that named surgeons' outcomes may not be appropriate for all operations.

Contact:
Ben Bridgewater, Consultant Surgeon, Wythenshawe Hospital, Manchester, UK
Tel: +44 (0)161 291 2511
Email: [email protected]

Click here to view full paper and Click here to view accompanying editorial