Surgeon specific mortality in adult cardiac surgery: Higher risk cases need also to be assessed

BMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7414.563-c (Published 04 September 2003) Cite this as: BMJ 2003;327:563
  1. Michael J O'Leary, specialist in intensive care (m.oleary{at}unsw.edu.au)
  1. St George Hospital, Kogarah, New South Wales 2217, Australia

    EDITOR—Risk adjusted outcomes are essential in interpreting surgeon specific mortality, but Bridgewater et al say that such adjustments do not discriminate in low risk patients (the majority) when baseline mortality is very low.1 They claim that the differences in surgeons' crude mortality rates are explained by variation in the case mix of high risk patients, which is not amenable to risk stratification. However, true differences are probably detectable only in this group.

    An underperforming surgeon is likely to create most havoc in this group of patients. Bridgewater et al recommend “a comparative analysis based on low risk cases without the need for further risk adjustment.” All this will achieve is to show that all surgeons fall within two standard deviations of the mean for the average case. Take another pat on the back.

    Knowing each surgeon's risk adjusted performance for the high risk cases would be interesting as it may well mirror their performance in the crude, non-adjusted rates and therefore show that crude death rates are indeed the most accurate way to proceed.


    • Competing interests None declared


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