Objectives: There is controversy on the proposed
benefits of publishing mortality rates for individual
surgeons. In some procedures, analysis at the level of
an individual surgeon may lack statistical power. The
aim was to determine the likelihood that variation in
surgeon performance will be detected using published
outcome data.
Design: A national analysis surgeon-level mortality
rates to calculate the level of power for the reported
mortality rate across multiple surgical procedures.
Setting: The UK from 2010 to 2014.
Participants: Surgeons who performed colon cancer
resection, oesophagectomy or gastrectomy, elective
aortic aneurysm repair, hip replacement, bariatric
surgery or thyroidectomy.
Outcomes: The likelihood of detecting an individual
with a 30-day, 90-day or in-patient mortality rate of up
to 5 times the national mean or median (as available).
This was represented using a novel heat-map
approach.
Results: Overall mortality rates for the procedures
ranged from 0.07% to 4.5% and mean/median
surgeon volume was between 23 and 75 cases. The
national median case volume for colorectal (n=55) and
upper gastrointestinal (n=23) cancer resections
provides around 20% power to detect a mortality rate
of 3 times the national median, while, for hip
replacement, this is a rate 5 times the national average.
At the mortality rates reported for thyroid (0.08%) and
bariatric (0.07%) procedures, it is unlikely a surgeon
would perform a sufficient number of procedures in
his/her entire career to stand a good chance of
detecting a mortality rate 5 times the national average.
Conclusions: At present, surgeons with increased
mortality rates are unlikely to be detected. Performance
within an expected mortality rate range cannot be
considered reliable evidence of acceptable
performance. Alternative approaches should focus on
commonly occurring meaningful outcome measures,
with infrequent events analysed predominately at the
hospital level.
CORE (COnnecting REpositories)
CORE (COnnecting REpositories)