Publishing surgeons' performance may encourage risk averse behaviour

July 03, 2003

Publishing the performance of individual surgeons using crude figures on death rates (as is planned in the United Kingdom) can be misleading and is not in the best interests of patients, conclude researchers in this week's BMJ.

All 8,572 patients undergoing heart bypass surgery for the first time between April 1999 and March 2002 in north west England were included in the study. Crude mortality for each surgeon and predicted mortality for each patient was calculated using a recognised scoring system. Mortality was defined as any in-hospital death.

A total of 23 surgeons performed these operations. Observed mortality between surgeons ranged from 0% to 3.7% while predicted mortality ranged from 2% to 3.7%. Most (85%) of patients had a low predicted mortality. Differences in predicted mortality between surgeons were due to a small proportion of high risk patients.

Crude comparisons of death rates are unfair and may encourage surgeons to practise risk averse behaviour, say the authors. Cardiac surgeons already work in a stressful environment, and the perception that a "bad run" might jeopardise their career may lead to a tendency to turn down high risk patients.

Instead, they recommend a comparison of death rates based on low risk patients as the national benchmark for assessing consultant specific performance.
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BMJ

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