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Surgery league tables could threaten access to care

April 16, 2002

Plans to publish details of the performance of individual surgeons could lead to a reluctance to treat riskier patients, according to a letter in this week’s BMJ.

Nicholas Pace, Consultant Anaesthetist at the Western Infirmary in Glasgow argues that before the NHS proceeds much further, note ought to be taken of experience in the United States, the country with most experience in the public release of such data.

For example, in Pennsylvania, where death rates for all surgeons providing coronary artery bypass surgery are published, 59% of cardiologists reported increased difficulty in finding surgeons willing to perform such surgery in severely ill patients who required it. Furthermore, 63% of the cardiac surgeons reported that they were less willing to operate on such patients.

Another study suggested that the movement of severely ill patients to an adjacent state had been a measurable effect of New York State’s public reporting of data on coronary artery bypass surgery.

It is unclear where these patients would move to if faced with similar problems in the United Kingdom, says the author. Access to health care for seriously ill patients would probably be decreased, ultimately leading to a decrease in NHS costs – a byproduct that would be welcomed by the government.

A further complication factor is that operative death is always attributed to the surgeon, but important influences such as anaesthetic care and intensive care resources are ignored, adds the author. “In other words, surgeons may be criticised for their postoperative morbidity when compared with their colleagues, but it may all be the fault of the anaesthetist,” he concludes.

British Medical Journal (BMJ)