Hospital Dr News

Call for outcome data to be widely published

All surgical specialties are being urged to share and publicly publish their outcome data as soon as possible.

The call comes after research on 400,000 cardiothoracic operations revealed that the outcomes for adult cardiac patients have improved dramatically over the past five years. Since 2001, the Society for Cardiothoracic Surgery of GB and Ireland has led the way on sharing and publishing its members’ data.

The Royal College of Surgeons of England claims the study, called Demonstrating Quality: The Sixth National Adult Cardiac Surgical Database Report, conclusively disproves critics who suggested that publishing mortality data would lead to risk-averse behaviour from surgeons, with the most sick and elderly patients being turned down for surgery for fear of blotting statistics.

In practice, the opposite has turned out to be true, it says, with the increase in reliable data emboldening surgeons to take on more complicated cases. More people who would have been considered too sick to undergo an operation just five years ago are now routinely treated and doing well.

The database findings provides evidence that, since national publication of mortality rates in cardiac surgery began eight years ago, the quality of care for patients has improved.

These include mortality rates for coronary artery surgery falling by 21% and for isolated valves by a third. For elective surgery in the under-70s mortality rate for coronary artery surgery is now less than one per cent.

The proportion of elderly patients being seen for surgery has increased. One in five coronary artery bypass patients were over 75 and five per cent over 80 years old.

And more diabetic, high blood pressure and overweight or obese patients are having cardiac surgery and mortality rates continue to fall.

The report also highlights areas for improvement, particularly the persistent gap in survival rates between the sexes – which favours men.  

Mr Ben Bridgewater, report author and consultant cardiac surgeon at University Hospital of South Manchester, said: “One of the benefits we are now seeing from public reporting of outcomes is not just about bringing poor performers into the pack but improving the performance of the pack as a whole. The very act of auditing services brings about improvements as centres learn from one another.”

Mr John Black, president of the Royal College of Surgeons, added: “This new report proves that open reporting works if well funded and led by the clinicians. 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.”

Read the data.

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