The results of the second year of mortality rates for around 5000 UK surgeons will be published this week. The publication of surgeon-specific data was prompted by the Bristol children’s heart surgery investigation and started with cardiac surgery. However, this was widened last year to cover more specialisms and this year’s statistics are expected to cover 12 areas of medicine.
NHS Medical Director Sir Bruce Keogh said that publishing surgeons’ mortality rates improved safety and he is determined to ensure that this data is both kept and published. He also suggested that there should be sanctions for surgeons who refuse to supply their mortality data.
Philippa Luscombe, partner in the clinical negligence team at Penningtons Manches LLP, comments: “The potential benefits of recording and publishing such statistics are clear. They should enable the identification of high mortality rates and an assessment as to whether any cause for concern is surgeon- or operation-specific. The statistics may also encourage surgeons to keep to their areas of specialism and enable patients to make an informed choice about who does their surgery. With the recent Saatchi Bill, it may also ensure that checks are kept on ‘pioneering’ surgery and the patient consent process is improved.
“The statistics cannot, however, provide a context for the results as some types of surgery are naturally more risky than others. For example, the risk of death from neurosurgery will always be higher than for foot surgery. Also, two surgeons may have wildly differing mortality rates for a type of surgery but one may, in fact, be more of an expert and therefore dealing with the more complicated cases. The current reporting of the statistics do not reflect that distinction so the fact one surgeon appears to have a high mortality rate may simply reflect completely different fields of surgery. It would be unfortunate if some of our best surgeons refused to operate in difficult cases because of concerns about their statistics.
“Another concern is that these statistics may alarm patients who may try to swap surgeons or hospitals, putting more strain on resources. Complication rates should also be considered as mortality is not the only potential adverse outcome. While every operation carries risks and some complications can occur without any fault, a high rate of complications for one surgeon may be an early indicator of a problem.
“This is one of our concerns about a group of current cases against Frimley Park Hospital in relation to a former consultant gynaecologist, Jayne Cockburn, and is a good example of where the monitoring and publishing of complication rates could have helped to identify the problem earlier and saved further patients from suffering injury. It will be interesting to see how far Sir Bruce Keogh takes this and whether enforcement action really is taken to ensure that all surgeons comply.“