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.


Related Mortality Articles from Brightsurf:

Being in treatment with statins reduces COVID-19 mortality by 22% to 25%
A research by the Universitat Rovira i Virgili (URV) and Pere Virgili Institut (IISPV) led by LluĂ­s Masana has found that people who are being treated with statins have a 22% to 25% lower risk of dying from COVID-19.

Mortality rate higher for US rural residents
A recent study by Syracuse University sociology professor Shannon Monnat shows that mortality rates are higher for U.S. working-age residents who live in rural areas instead of metro areas, and the gap is getting wider.

COVID-19, excess all-cause mortality in US, 18 comparison countries
COVID-19 deaths and excess all-cause mortality in the U.S. are compared with 18 countries with diverse COVID-19 responses in this study.

New analysis shows hydroxychloroquine does not lower mortality in COVID-19 patients, and is associated with increased mortality when combined with the antibiotic azithromycin
A new meta-analysis of published studies into the drug hydroxychloroquine shows that it does not lower mortality in COVID-19 patients, and using it combined with the antibiotic azithromycin is associated with a 27% increased mortality.

Hydroxychloroquine reduces in-hospital COVID-19 mortality
An Italian observational study contributes to the ongoing debate regarding the use of hydroxychloroquine in the current pandemic.

What's the best way to estimate and track COVID-19 mortality?
When used correctly, the symptomatic case fatality ratio (sCFR) and the infection fatality ratio (IFR) are better measures by which to monitor COVID-19 epidemics than the commonly reported case fatality ratio (CFR), according to a new study published this week in PLOS Medicine by Anthony Hauser of the University of Bern, Switzerland, and colleagues.

COVID-19: Bacteriophage could decrease mortality
Bacteriophage can reduce bacterial growth in the lungs, limiting fluid build-up.

COPD and smoking associated with higher COVID-19 mortality
Current smokers and people with chronic obstructive pulmonary disease (COPD) have an increased risk of severe complications and higher mortality with COVID-19 infection, according to a new study published May 11, 2020 in the open-access journal PLOS ONE by Jaber Alqahtani of University College London, UK, and colleagues.

Highest mortality risks for poor and unemployed
Large dataset shows that income, work status and education have a clear influence on mortality in Germany.

Addressing causes of mortality in Zambia
Despite the fact that people in sub-Saharan Africa are now living longer than they did two decades ago, their average life expectancy remains below that of the rest of the world population.

Read More: Mortality News and Mortality Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to