Bypass surgery mortality is blunt measure of performance

doi:10.1136/bmj.329.7470.856-a

BMJ 2004;329:856 (9 October), doi:10.1136/bmj.329.7470.856-a

Letter

Bypass surgery mortality is blunt measure of performance

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

EDITOR—Kmietowicz reports that UK heart surgeons are amongthe best in the world as measured by crude mortality of isolatedcoronary artery bypass surgery.¹ This marker of surgical performanceis widespread.

Imagine the following scenario. A patient undergoing isolatedbypass grafting has an uneventful procedure. During closure,the systemic blood pressure drops, and the electrocardiogramshows that the patient is becoming ischaemic. Cardiopulmonarybypass is reintroduced rapidly, but a further attempt to weanfrom circulatory support is unsuccessful. The surgeon, who issubject to mandatory reporting of such cases, notes the smalland insignificant jet of mitral regurgitation seen on the intraoperativetransoesophageal echo. He readministers cardioplegia and performsa mitral valve repair. The patient dies, but the death is notrecorded on the surgeon's ledger, as no longer is the procedurean isolated coronary artery graft case.

Corridor whispers imply that the above vignette has occurred.I . . . [Full text of this article]

Ian S Gilfillan, cardiothoracic surgeon

Fremantle Hospital, Fremantle, WA 6160, Australia ian.gilfillan@health.wa.gov.au

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