Public reporting of mortality rates in specialties with low surgical numbers may lead to false complacency

Researchers have found public reporting of mortality rates for individual surgeons will not have the intended effect of identifying surgeons with poor performance in specialties with a low number of procedures annually, and may instead lead to additional issues like false complacency.

“The reporting of results for individual surgeons should be based on outcomes that are fairly frequent, and fortunately, from the point of view of patients, mortality is not one of them,” Jenny Neuburger, PhD, from the London School of Hygiene and Tropical Medicine, stated in a press release.

Neuburger and colleagues examined mortality rates for hip fracture, adult cardiac, bowel cancer resection, oesophagectomy or gastrectomy surgeries to find how many surgeries are needed for sufficient statistical power. The study was created in response to a new policy from the English National Health Services (NHS) that will help patients choose their surgeon and will help clinicians improve care.

Overall, the researchers found the surgeons in NHS do not perform enough procedures annually to reveal surgeons who are performing poorly. Specifically, they found bowel cancer surgery procedures comprise about one-tenth the number necessary for 60% statistical power – meaning that for every 10 surgeons who perform poorly, on average 6 surgeons would be identified. Oesophagectomy or gastrectomy procedures comprise about one-tenth the number for 70% power. Hip fracture surgeries and cardiac surgeries are more prevalent in NHS, but still comprise 41% and 75% of the number of surgeries needed for 70% statistical power, respectively.

“The danger is that low numbers will mean that chance factors overwhelm the influence of surgeon performance on the number of deaths,” Neuburger said. “This could mask poor performance and lead to false complacency.”

For specialties with low surgery numbers, the researchers recommended pooling 3-year and 5-year data to determine poor surgical performance. However, they noted this may be an inaccurate way of judging poor performance, as this method does not account for the surgeon’s skills and practice changing.

“For specialties in which most surgeons do not perform sufficient numbers of operations to reliably assess their outcomes, reporting should be at the level of the surgical team or hospital, and not the surgeon,” Neuburger said.

Reference:

Walker K. Lancet. 2013;doi:10.1016/S0140-6736(13)61491-9.

Disclosure: The authors have no relevant financial disclosures.