Chance of identifying poor surgeons from mortality data is low, say analysts

BMJ 2013; 347 doi: (Published 05 July 2013) Cite this as: BMJ 2013;347:f4377
  1. Nigel Hawkes
  1. 1London

Publishing patient death rates for individual surgeons will not identify all poor performers and may create a sense of false reassurance, warns a team from the London School of Hygiene and Tropical Medicine in the Lancet.1

In many specialties surgeons do not do enough operations, and nor is death a common enough outcome, for the data to have the statistical power from which to draw safe conclusions, say Jenny Neuberger and colleagues. Individual surgeons’ mortality rates have already begun appearing, and more will follow in the next few months. The NHS’s medical director, Bruce Keogh, has hailed the release of the data as “a major breakthrough in NHS transparency.”

But the London team said that the chances that the data would identify a poorly performing surgeon were low. For hip fracture surgery, for example, surgeons would need to conduct 75 operations a year for there to be a 70% chance of detecting that their death rates were double the national average. The median number of hip fracture operations is much lower: 31 a year. For bowel cancer resection, the figures are even worse: it would take 132 operations a year …

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