Surgeons' success rates 'must be public'
Britain's 6,000 surgeons must be more open about what they do and accept assessment of the outcomes of their operations to guarantee patient safety, according to the leader of their professional body.
Allowing patients to check a doctor's performance record before going under the knife – as they can already do for heart surgery – is the only way they can exercise genuine choice over where to go for treatment, said Bernard Ribeiro, president of the Royal College of Surgeons.
"Cardiac surgeons have been doing this for years. Ultimately, our aim is that data on all surgical procedures should be available – but that isn't going to happen tomorrow," he said. "We want to provide information for patients. It will bring much more sophisticated choice." Mr Ribeiro added: "This is about safety. More patients are cured of cancer by surgery than by any other intervention. It is the skill of the surgeon and the supporting team that determines it. It is better [for patients] to travel to get good quality care than to stay locally for convenience."
His remarks, which are bound to ruffle feathers among his colleagues, come as the health ministry prepares to collect information on how patients rate their health before and after surgery – rather than merely counting operations. In a world first, the NHS will in April begin measuring success rates in four operations – hip and knee replacements, and hernia and varicose vein repairs – by asking 250,000 patients a year to fill in simple questionnaires.
The survey, run by the Royal College of Surgeons and the London School of Hygiene and Tropical Medicine, is the first time any healthcare system has tried to systematically assess the outcomes of surgery. A procedure may appear technically successful to the surgeon but leave the patient in pain or immobile.
The Royal College will independently assess 10 per cent of the operations. Mr Ribeiro, whose three-year term as college president ends in July, said getting the profession to accept assessment was a key objective of his remaining tenure. "Trust is a big issue in medicine. Trust comes with information. The patient who has information will trust the doctor," added Mr Ribeiro, a consultant at Basildon University Hospital.
Heart surgery death rates, published since 2004, show a six-fold difference between the best and worst performing units. Last year, the Healthcare Commission criticised Oxford Radcliffe NHS Trust for failing to investigate when it emerged that its 2005 death rate was twice the national average.
Mr Ribeiro said surgical outcomes were harder to gauge in other specialties where deaths were rare, but an attempt must still be made, for example, by recording complication, readmission or infection rates.
"To produce data that is robust, believable and trusted by surgeons and everyone else is a mammoth task," he said. "In the past 18 months we have discussed it with the specialty associations [representing separate branches of surgery] and they have been very supportive.
"We will be working ultimately to the position that the cardiac surgeons are in. It is a challenge but I think surgeons will rise to it."
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