28 June 2013
NHS Surgeons with the highest death rates: what do the figures tell us?
The NHS is making public patient death rates for 458 vascular surgeons. The Health Secretary says that publishing this data will drive up standards in patient care and could literally save lives. Similar information will follow shortly for doctors in other disciplines.
One might think these figures would show us who are the best surgeons and who to avoid. 6 surgeons have refused to give their figures. Does this mean they have something to hide?
I am sceptical about this whole enterprise. The assumptions behind it are first that we are comparing like with like and secondly that success or failure is all down to the individual surgeon. I doubt that either is true.
Are we comparing like with like? There are large number of factors besides a surgeon’s skill which will affect the outcome of surgery. Older patients and those with poorer health are bound to have poorer outcomes to surgery than others. Smoking, obesity, diabetes and other conditions increase failure rates. Some hospitals will serve patients with poorer general health profiles than others. Further difficult, specialist and high risk procedures will by definition have higher death rates. Not all surgeons will be able or willing to perform these operations. It could be the case that the best surgeons have high death rates because they take on cases others will not.
Is it all down to the surgeon? The reality is that surgery involves team work. The surgeon is supported by other surgeons and by scrub nurses. The anaesthetist is there to keep the patient alive. There is a whole team of people involved. Besides people, different facilities will be involved in different hospital. There are therefore a large number of factors affecting the outcome besides the surgeon’s skill.
I approach this subject as someone who acts for patients who have suffered injury as a result of negligence. A lot of my time is spent analysing why things have gone wrong. A number of my cases concern things going wrong in surgery. And it is not always down to the surgeon.
The new NHS statistics may give us some useful information. But my concern is that this is likely to be another simplistic approach to assessing something which is actually very complex. The statistics may mislead as much as they enlighten.