All vascular surgeons are performing within expected limits, show individual outcome data

BMJ 2013; 346 doi: (Published 28 June 2013) Cite this as: BMJ 2013;346:f4205
  1. Zosia Kmietowicz
  1. 1BMJ

The first ever audit of consultant level outcomes from vascular surgery has found that all UK surgeons are performing within the expected range and that just six of 472 surgeons (1.3%) refused to consent to have their outcome data published.

The audit covers the results of surgery for patients who underwent elective repair of an infra-renal abdominal aortic aneurysm (AAA) and carotid endarterectomy.1 The individual level data are part of NHS England’s commitment, made last December, to publish the outcomes for surgeons in 10 specialties, which it hoped would improve transparency and drive up standards.2

The information is being posted on the NHS Choices website alongside the outcome data for cardiothoracic surgeons, for whom individual results have been published since 2005. The names of surgeons who have not consented to their data being included will appear on the website along with their reasons for taking this action.

The Vascular Society, which produced the audit, has been reporting unit level outcomes for the two types of surgery for eight years, during which time the mortality rate after elective infra-renal AAA repair in the UK fell from 7% in 2008 to 2.4% in 2013.

The data on individual surgeons show that, after adjustment for case mix, there were no outliers—those defined as performing outside expected limits.

The information for AAA surgery relates to 458 surgeons and was based on five years of data and from 21 266 patients who had their operation between January 2008 and December 2012. Surgeons performed between one and 237 operations each over five years, with a median of 32 operations. Overall 2.2% of patients died in hospital, and the death rate for individual surgeons ranged from 0% to 31.3%.

For carotid endarterectomy the information relates to 15 751 patients who were operated on between October 2009 and September 2012 by 429 surgeons, who performed between one and 165 procedures each, with a median of 31 over three years. The audit found that overall the proportion of patients who died or had a stroke within 30 days of the operation was 2.4%, with a range among surgeons from 0% to 18.2%.

The report said that some surgeons may have few procedures recorded because they only became consultants in the past year or two, because some may have had only a few patients with infra-renal AAA, and because data on some patients may not have been submitted or were incomplete.

Julian Scott, president of the Vascular Society, said that the data should not be used to compare one surgeon with another.

He said, “When analysing this information it is vital to understand that many surgeons now operate jointly for complex cases such as AAA, and this cannot be reflected in the current data, as the operation is only assigned to one consultant. As a result unit or hospital level data may be a better guide to quality, as it reflects the results of the surgical team far better.

“To simplify consultant level data to a discussion around league tables is highly misleading and cannot be justified.”

Scott emphasised that patients’ cases are discussed at multidisciplinary meetings and are managed by a variety of healthcare professionals, not by just one consultant surgeon.


Cite this as: BMJ 2013;346:f4205