Intended for healthcare professionals


Heart surgeons are to be rated according to bypass surgery success

BMJ 2003; 326 doi: (Published 15 May 2003) Cite this as: BMJ 2003;326:1053
  1. Owen Dyer
  1. London

    Britain's heart surgeons are to be publicly graded on their performance on a three star rating system that classes them according to the survival rates of their patients.

    The Society of Cardiothoracic Surgeons says it has opted for the scheme to forestall government plans to introduce performance league tables. The society argues that the government's plans would penalise consultants who take on high risk patients.

    Rather than covering all cardiac surgery, the ratings will be based on coronary artery bypass grafts without additional procedures, conducted on adults having cardiac surgery for the first time. The society believes that including rare and dangerous procedures in the data without adjustment for risk could distort the statistical picture.

    First time bypass surgery is a staple of the work of cardiac surgeons, accounting on average for about two thirds of their operations. In Britain the mean mortality for this procedure is 2.1%. Under the society's scheme any surgeon who is close to the national average will receive two stars, while one star and three star ratings will be reserved for surgeons who are well outside the normal range. All 180 surgeons who perform this work will be rated later this year, with the time and place of publication yet to be decided.

    The statistics will be compiled from a three year rolling database, with risk stratification and other procedures being phased in over the next few years. While the society will provide data for all surgeons, individuals' performance ratings will probably be published only in England and Wales, as the Scottish Executive has opted for a unit based approach. Northern Ireland has only one specialist cardiac unit.

    Colin Hilton, the society's president, said most heart surgeons preferred the idea of performance tables for cardiac units over ratings of individual surgeons, but the society had been put “between a rock and a hard place” by the government's pledge to introduce performance ratings by 2004. Individual ratings were a key recommendation of the Kennedy report into high mortality among children under-going heart surgery at the Bristol Royal Infirmary.

    “The data the government would have used is frankly unreliable, but ours is not perfect either,” said Mr Hilton. “People should be aware of these figures for what they are. They are not risk stratified. A higher mortality rate could be due to poor intensive care, for example, or cardiologists sending sicker patients for surgery. It may have nothing to do with the quality of surgery.”

    He added that the current data had few outliers, so there would be very few one star surgeons and possibly no three star surgeons in this year's ratings. “The media has portrayed this as a first step towards patients choosing their surgeon, but frankly if there are five or so consultants in the country with three stars, you're not going to be able to demand one of them.”

    View Abstract