BMJ  2003;326:1397 (21 June), doi:10.1136/bmj.326.7403.1397

Letter

Mortality control charts

Assessment of outcome is complex

The first 150 words of the full text of this article appear below.

EDITOR—Tekkis et al's analysis of two databases for comparing performance of surgical units seems to be an improvement on existing models of risk stratification especially with the recently published annual assessments by the Dr Foster group.1

Case mix influences outcome of surgery. Surgeons who specialise in colorectal surgery, undertake a disproportionate number of elective (low risk) cases, and as such their results may appear superficially better. Murray et al have shown that adjustment for case mix leads to a substantial change in the relative performance of surgeons.2 Sagar et al have shown that by adjusting for patient differences the initial appearances of the data may be reversed.3 These referral practices are hard to "control for" by examining only preoperative risks and mortality outcomes.

We agree with Jacobsen et al in their editorial on hospital mortality league tables in the same issue that hospitals are complex systems that are . . . [Full text of this article]

Frank A Frizelle, professor of colorectal surgery

frank.frizelle@cdhb.govt.nz

John Frye, surgical registrar

University Department of Surgery, Christchurch Hospital, Riccarton Ave, Christchurch, New Zealand


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Relevant Article

Mortality control charts for comparing performance of surgical units: validation study using hospital mortality data
Paris P Tekkis, Peter McCulloch, Adrian C Steger, Irving S Benjamin, and Jan D Poloniecki
BMJ 2003 326: 786-788. [Abstract] [Full Text] [PDF]

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