Surgeons’ performance data to be available from July

BMJ 2013; 346 doi: (Published 11 June 2013) Cite this as: BMJ 2013;346:f3795
  1. Krishna Chinthapalli
  1. 1BMJ

Data on performance of individual surgeons in nine specialties will be published from the beginning of July, the Royal College of Surgeons announced on 10 June.

Norman Williams, the college’s president and a colorectal surgeon, said at a press briefing, “We really do see this as a watershed moment for the profession, and it is all about transparency. I think it is most appropriate, particularly after the Francis report [on failings at Mid Staffordshire NHS Foundation Trust] . . . and what we want to do is drive up standards to get everybody up to a really excellent standard.”

The move comes after NHS England’s commitment to publish outcomes for individual surgeons in December 2012.1 For the first time, publication of data will cover all NHS operations of named consultant surgeons in bariatric surgery, colorectal surgery, head and neck surgery, orthopaedic surgery, thyroid and endocrine surgery, upper gastrointestinal surgery, urological surgery, and vascular surgery. Cardiac surgeons have been reporting outcomes for named consultants since 2005.2 One non-surgical specialty, interventional cardiology, will also publish individual performance data from July.

The data will be collected from existing national audits overseen by specialty societies, the Royal College of Surgeons, and the charity the Healthcare Quality Improvement Partnership. After adjustment for risk, the information will be published on the NHS Choices website.

David Cromwell, a senior lecturer at the London School of Hygiene and Tropical Medicine and methodologist for many of the audits, said, “You’ll probably get a set of figures indicating the surgeon, the number of operations they’ve performed, and some measure of outcome. In most cases it will probably be the proportion who died after surgery.”

If a surgeon were performing above the upper limit of random variation for complications, Cromwell said that the first step would be to allow the surgeon to check the data for errors. He added, “Once they’ve done that we would reanalyse the data. Only then, if they fell outside the limit continually, then there will probably be a question to ask and we’d have to go in and look at more processes.”

Williams noted that standards had risen in cardiac surgery since publication of outcome data but also expressed concerns. “This is a complex area, and there are various things to understand. I could be classified as an outlier because the data were wrong . . . I might also be an outlier because I’m operating on very high risk patients who are extremely elderly and are likely to, sadly, succumb,” he said.

Martyn Porter, president of the British Orthopaedic Association, agreed. “It would be wrong of me to give the impression that all orthopaedic surgeons are comfortable with the concept of public disclosure and publication of results,” he said. “There are genuine concerns that incorrect or poorly validated data would not aid patient choice . . . There are also views that the data are complex and require contextualisation to assist interpretation.

“To my knowledge this is the only country in the world that is intending to publish at the individual level, and I think it is fair to say the international community is looking at this with a great deal of interest.”

Williams expected that the audits would be refined over time and thought that potential consequences could include inexperienced consultants referring difficult cases to colleagues and a reconfiguration of surgical services in England. “There is no getting away from it: if you want to have a better result as a patient you’re better off in a bigger unit that is doing these things day in, day out. There is no argument about it,” he said.

Williams also acknowledged that there had been pressure to publish data on outcomes from organisations such as the BMJ.3 4 He said, “I remember reading an editorial saying why is it that cardiac surgeons are the only ones presenting [individual data]. We’re actually answering [the BMJ’s] call. We’re trying to widen it. We say to the rest of the profession, ‘It’s about time you did as well.’ We’re happy to lead, but I think GPs, diabetologists, geriatricians, psychiatrists should be stepping up to the plate as well.”


Cite this as: BMJ 2013;346:f3795