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Surgery outcomes published for the first time

Consultant vascular surgeons have published their outcomes for the first time.

The Vascular Society has released details of consultant-level outcomes after vascular surgery in its the National Vascular Registry 2013 Report on Surgical Outcomes: Consultant-level Statistics.

The report presents information on the results of surgery for patients who underwent two types of vascular procedures: elective repair of an infra-renal Abdominal Aortic Aneurysm (AAA) and stroke prevention surgery or carotid endarterectomy (CEA).

As surgeons prepare for the publication of consultant-level outcomes data for nine areas of surgery this summer on the NHS Choices website, the Registry builds on the UK wide quality improvement programmes that vascular surgeons have been running since 2005.

The Society has been reporting unit-level outcomes for AAA and CEA and has seen significant improvement in surgical performance in the last eight years. This reporting has led to the rate of mortality after elective infra-renal AAA repair in the UK falling from 7% in 2008 to 2.4% in 2013.

The data reveals that no surgeon had an outcome outside the expected range – so there were no outliers. Data were adjusted to take into account the varying risk profiles of differing patients (this is called “case mix adjustment”). This ensures that surgeons who take on complex, higher risk cases are not unfairly criticised for having higher death rates.

It also highlights that six consultants did not consent to have their surgical outcomes published. Their data was, however, included in the analysis of surgical outcomes and their results were also within the expected range.

Following the health secretary’s recent intervention, the names of non-consenters will be ‘named and shamed’ on the NHS Choices website along with their reasons for taking this action.

For elective infra-renal AAA surgery, the report gives the number of procedures performed by NHS trusts and consultants and the proportion of patients who died before discharge after their surgery (post-operative mortality). The figures are based on five years of data, and relate to 21,266 patients who had their operation between January 2008 and December 2012.

For the 15,751 patients who underwent carotid endarterectomy surgery between October 2009 and September 2012, the report provides figures on the number of procedures, the average delay from symptom to surgery and the proportion of patients who died or had a stroke within 30 days of the operation.

Professor Julian Scott, president of the Vascular Society, said: “When analysing this information it is vital to understand that many surgeons now operate jointly for complex cases such as AAA and this cannot be reflected in the current data as the operation is only assigned to one consultant. As a result unit/hospital-level data may be a better guide to quality as it reflects the results of the surgical team far better. To simplify consultant-level data to a discussion around league tables is highly misleading and cannot be justified.

“Surgeons in these tables should not be ranked by their mortality rate as there is a risk that they will be wrongly criticised and patients misled. Some are conducting extremely difficult surgery on very sick people so will have relatively high mortality rates. In all of these cases the patients are discussed in an MDT and the opinion is shared with the patient and their families. If they decide to undergo surgery, these patients are managed on a daily basis by a variety of health care professionals and not by just by one consultant surgeon.”

The audit presents outcomes information for consultants working within the UK. It gives figures for consultants and NHS trusts/health boards. The data has been independently analysed by clinical methodologists and statisticians at the Royal College of Surgeons Clinical Effectiveness Unit. The statisticians looked at the results of surgery to see if these could be explained by surgeon behaviour rather than small variations between patients.

Commenting on the publication of outcome data, Professor Norman Williams, president of the Royal College of Surgeons, said: “This is an historic moment for surgery, and I’m enormously proud of what surgeons up and down the country have achieved. It has been a difficult and complex undertaking carried out in a short timescale but we see this as the beginning of a new era for openness in medicine. It is early days, but it will change for the better the nature of the bond between patient and surgeon, which is based on both openness and trust.

“Clinical audits are a way of measuring performance,  but it is really important that any analysis of the work of surgeons who take on higher risk patients, such as those with complex health needs like diabetes or respiratory problems, must reflect the complexity of these conditions. We must not deter surgeons from treating difficult cases for fear of being penalised.”

Read the report.

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One Response to “Surgery outcomes published for the first time”

  1. Bemused says:

    Mortality figures are very blunt. I would be more concerned about morbidity figures. I wonder if those lower mortality cardio thoracic and vascular centres have higher rates of cerebral compromise and other morbidities?

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