BMJ  2003;327:73 (12 July), doi:10.1136/bmj.327.7406.73

Paper

Assessment of whether in-hospital mortality for lobectomy is a useful standard for the quality of lung cancer surgery: retrospective study

¹ Cardiothoracic Unit, Guy's Hospital, London SE1 9RT, ² Clinical Operational Research Unit, University College London, London WC1E 6BT, ³ Society of Cardiothoracic Surgeons of Great Britain and Ireland, London WC2A 3PE

Objectives To calculate in-hospital mortality after lobectomy for primary lung cancer in the United Kingdom; to explore the validity of using such data to assess the quality of UK thoracic surgeons; and to investigate the relation between in-hospital mortality and the number of procedures performed by surgeons.

Design Retrospective study.

Setting 36 departments dealing with thoracic surgery in UK hospitals.

Participants 4028 patients who had undergone lobectomy for primary lung cancer by one of 102 surgeons.

Main outcome measures In-hospital mortality in relation to individual surgeons, among all patients, and among each of five groups of patients defined by the number of operations performed by the surgeon.

Results 103 patients (2.6%, 95% confidence interval 2.1% to 3.1%) died after surgery during the same hospital admission. No significant difference was found for in-hospital mortality between the five groups.

Conclusions The number of procedures performed by a thoracic surgeon is not related to in-hospital mortality. Reporting data on in-hospital mortality after lobectomy for primary lung cancer is a poor tool for measuring a surgeon's performance.

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Rapid Responses:

Read all Rapid Responses

Challenges no surgeon would refuse

Richard G Fiddian-Green
bmj.com, 11 Jul 2003 [Full text]

Complexity of case load

James C Hurley
bmj.com, 14 Jul 2003 [Full text]

Preventable or Predicted lobectomy mortality: A calculated or down right callous risk?

Joseph F. KHALIL-MARZOUK
bmj.com, 23 Jul 2003 [Full text]

Making the Excellence more infectious.

Mangesh, A Thorat
bmj.com, 2 Aug 2003 [Full text]