Facing up to surgical deaths

BMJ 2004; 328 doi: https://doi.org/10.1136/bmj.328.7436.361 (Published 12 February 2004) Cite this as: BMJ 2004;328:361
  1. Marc R de Leval, professor of cardiothoracic surgery (delevm@gosh.nhs.uk)
  1. Cardiothoracic Unit, Great Ormond Street Hospital for Children NHS Trust, London WC1N 3JH

    Each death should be subjected to forensic and statistical analysis

    This issue of the BMJ contains two articles on surgical mortality. The first considers the well rehearsed problem of statistical monitoring of surgical performance, whereas the second considers the less researched issue of the impact of surgical death on healthcare providers. Poloniecki et al apply retrospectively seven different statistical tests to compare with a benchmark the death rate in a transplantation programme that was closed because of concerns that the death rate was too high.1 They show that the point at which an alarm would have occurred had a prospective analysis been carried out varied with the choice of method and that the most scientifically appealing method (mortality chart adjusted for cumulative risks) would have detected only a decrease in the death rate early in the series. This paper is an invitation to reflect on the purpose and usefulness of statistical analysis to monitor performance in health care.

    Medical audit was introduced by Florence Nightingale in the 19th century as a process of healthcare improvement. As time …

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