Patient report that benefit from common operations varies markedly by English providers

BMJ 2012; 345 doi: (Published 16 August 2012) Cite this as: BMJ 2012;345:e5563
  1. Nigel Hawkes
  1. 1London

A wide variation occurs in the benefits reported by patients for four procedures covered by patient reported outcome data—hip and knee replacements, groin hernia surgery, and varicose vein surgery—depending on where in England the surgery was done, show results from the second year the data have been collected.1

The results of the Patient Reported Outcome Measures (PROMs) for 2010-11 are published by the Health and Social Care Information Centre. They show, for example, that while 80.4% of patients having a hip replacement at Barking, Havering, and Redbridge University Hospitals NHS trust in Essex showed a benefit when measured by the EQ-5D scoring system, at Shepton Mallet NHS Treatment Centre in Somerset 96.4% did so. The national average was 86.9%.

The “average adjusted health gain” measured by EQ-5D for hip replacements was 0.264 at Barking, and 0.494 at Shepton Mallet, against a national average of 0.405. Using an alternative system, EQ-VAS, Barking scored 2.538 and Shepton Mallet 13.333 (national average 9.184), and, on the Oxford Hip Score, Barking scored 14.880 and Shepton Mallet 23.590.

Some might argue that an NHS Treatment Centre can cherry pick the easier cases, but Hampshire Hospitals NHS Foundation Trust, which is not open to this charge, did very nearly as well, and the Horder Centre in Crowborough, Sussex, a specialist NHS unit, is singled out by the report as one of only two centres (the other being Shepton Mallet) that did well enough to be a positive outlier—significantly better than average—in both 2009-10 and 2010-11.

Given the right to choose and book, a well informed Barking patient might well think it worthwhile travelling 50 miles to Crowborough for a hip replacement, or a patient in North-West England might pick Wirral University Teaching Hospital NHS Foundation Trust (health gain on the EQ-VAS index 7652) rather than Blackpool Teaching Hospitals NHS Foundation Trust (4072).

The outcome measures depend on patients filling in forms before and after their operations. In 2010-11 almost 70% filled in the pre-operative form and 81% the postoperative one, a good response rate. The provisional data for 2011-12 show an even better figure for the pre-operative forms of 74.0%, but it is too soon to record a final figure for the post-operative ones.

National scores have changed little since 2009-10, and hip and knee replacements continue to contribute more to patients’ perception of their general health than do hernia or varicose vein surgery. While almost 87% of hip patients and 78% of knee patients record an improvement in general health after the operation, the same is true of only 51% of groin hernia patients and 52% of varicose vein patients. But many in the latter two categories felt that they had good general health before surgery, so their range of possible improvement was more limited.

The data are presented in a form that enables users to specify a procedure and a measure, and find how each provider in England compares to others or to the national average. The measures differ significantly, EQ-5D identifies condition-specific issues through five weighted questions, while EQ-VAS asks patients to score their health on a scale of 0 (worse) to 100 (better) on the day they fill in the form, so it may reflect health conditions other those for which they had surgery. The Oxford Hip and Knee scores and the Aberdeen Varicose Vein Questionnaire focus on the specific condition. For example, the Oxford score, which runs from 0 (worse) to 48 (better) asks about issues such as pain, ease of movement, and ease of undertaking normal activities such as walking or climbing stairs.

Tim Straughan, chief executive of HSCIC (which used to be known as the NHS Information Centre) said: “The importance of patient survey information to the NHS has been made clear in recent years; and today’s [15 August] figures represent a significant step in being able to gain a clear understanding on how people personally feel about their health after common procedures like knee and hip replacements and how this has changed in time.

“Patients and health professionals alike will have great interest in today’s results—which offer an unprecedented two year insight of not just the nuts and bolts of NHS activity, but the viewpoint of people who have experienced these procedures.”


Cite this as: BMJ 2012;345:e5563


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