Research Suggests Public Reporting Unlikely to Detect Poorly Performing Surgeons

Research Suggests Public Reporting Unlikely to Detect Poorly Performing Surgeons

A new study conducted by researchers from the London School of Hygiene & Tropical Medicine, published in the online journal The Lancet reveals that the recent decision taken by England’s NHS (National Health Service) to publish the mortality rates of each surgeon is very unlikely to identify the poorly performing surgeons due to the fact that certain surgery specialties have only a low number of surgeries that can be taken into consideration. The surgical branch is only one of the 10 medical branches targeted by the NHS.

According to Jenny Neuburger, one of the lead authors of the study, the mortality rates of procedures such as bowel cancer resection can’t be accurate due to the uncommon nature of the procedure. However, regarding procedures that are more common, such as cardiac surgeries, the individual performance of surgeons can be assessed through this method. According to Neuburger, the low number of surgery procedures means that the performance of individuals surgeons could be overwhelmed by chance factors that are responsible for the death of patients.

The research team analyzed the nationwide mortality rates for 5 different types of surgical procedures. These procedures are cardiac surgery, gastrectomy, oesophagectomy, hip fracture surgery and bowel cancer resection. Based on the collected data, researchers calculated the amount of surgical procedures needed to create a reliable detection of poor individual performance. Furthermore, the research team analyzed the number of procedures conducted in England’s NHS-affiliated hospitals. The results show that the actual number required for a correct assessment of poor individual performance exceeds the number of annual surgical procedures conducted by surgeons.

As an example, in order to achieve a statistical power of over 60% (meaning that 6 of 10 poorly performing surgeons would be detected through the method) for bowel cancer surgical procedures, researchers estimate that there need to be at least 10 times more bowel cancer surgeries performed annually. After analyzing data collected from the past 3 years, researchers determined that cardiac surgeons and hip-fracture surgeons were performing enough surgical procedures annually, thus poor performing individuals could be detected. However, for the other procedures, analyzed data reveals that less than 20% of the needed surgical procedures are performed.

The NHS aims towards higher transparency regarding individual performance of English surgeons, in order to help patients chose the best available surgeons. However, such public disclosure could only be useful if the data is accurate. Dr. Neuburger concludes that only data collected from surgeons who perform enough surgical procedures every year could be introduced into the database. However, she adds that these reports should contain data that is based on frequent outcomes of surgery, not mortality. Thus, surgeons who do not perform enough surgical procedures can also be included into the database based on the outcomes of their procedures. Dr. Neuburger also affirms that these reports should be aimed towards the performance of surgical teams and/or hospitals, instead of being focused on the surgeon as an individual.