Quality | 2009.07.29
Public data aids fall in heart op deaths
Analysis dispels myth that surgeons are more likely to refuse to operate on risky cases if data is made public
The death rates of people undergoing heart operations have dropped dramatically over the last few years – ever since surgeons started publishing the figures, it will be revealed tomorrow.
The data on 400,000 operations over the last five years, published by the Society of Cardiothoracic Surgery , shows death rates in coronary artery surgery have fallen by 21% and in aortic valve replacement operations by one third, despite the fact the age of the patients and the complexity of their conditions has increased.
The most detailed analysis yet of the outcomes for heart patients comprehensively dispels the myth that surgeons are more likely to refuse to operate on risky cases if the data is made public, for fear of being seen to have a high death rate.
When, in March 2005, the Guardian used the Freedom of Information Act to collect and publish death rates for individual surgeons in every unit in the NHS, many objected on the grounds that allowing the public to know would make doctors risk-averse.
But tomorrow, the Royal College of Surgeons will call for all doctors, not just heart surgeons, to be more open about their results – both in terms of deaths and other outcomes. The college is backed by the former General Medical Council (GMC) president Sir Donald Irvine, who set in train the process of revalidation of doctors. All doctors are now supposed to prove their fitness to practice on a five-yearly basis, but Irvine said that collection and publication of their results would be more meaningful than most measures. The heart surgeons, said Irvine, had shown what could be done. "Whether the profession is really up for doing this well or looking at a tick box minimalist approach – the jury is still out on that," he said.
The heart surgeons embarked on data collection after the Bristol babies scandal, when it emerged that some children who died after heart surgery at the Bristol Royal infirmary would have had a better chance of survival at other hospitals. Two senior doctors were struck off the GMC register and a third was suspended as a result.
"I think they took the lesson from Bristol and decided the kind of recording they were doing really wasn\'t any good and they were capable of doing a good deal better," said Irvine. "They have really come up with very good data which is still in the process of being refined. They are now getting to the point where they can look the public in the eye and say we know pretty accurately how individual surgeons perform and whether they are functioning below or above the line."
John Black, president of The Royal College of Surgeons , also urged other doctors to imitate the heart surgeons. "This new report proves that open reporting works if well funded and led by the clinicians," he said. "All branches of surgery are following the trail on reporting outcomes that cardiac surgeons have blazed and this should spur those efforts on.
"All of medicine should take note of the findings that full audit has not resulted in risk-averse behaviour."
Ben Bridgewater, consultant cardiac surgeon at the University Hospital of South Manchester and author of the report, said the data collection and analysis had become increasingly sophisticated.
"It was accepted a few years ago that mortality is important but a relatively crude measure," he said. The society is now looking at data on complications, length of stay, re-admissions and other factors which give a better picture of the skill of the surgeon and his unit, as well as the health of the patient before surgery.
In a cash-strapped NHS, Bridgewater said, it would be increasingly important to be sure that the quality of care was as high as it could be, to minimise a patient\'s length of hospital stay and reduce the chances of re-admission for complications.
The collection and comparison of data, he added, should be "the core business of what professional societies and colleges should be doing".
The report enables individual surgeons, heart units and whole hospitals to benchmark themselves against their peers to ensure the quality of their work is as high as it can be.
The Society of Cardiothoracic Surgery, together with the Care Quality Commission, publishes heartsurgery.cqc.org.uk, where patients can see the survival rates during surgery at individual hospitals.
For more information, please visit
http://www.guardian.co.uk/lifeandstyle/2[...]heart-surgery-death-rates-fall
