Surgeons call for death-rate checks

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The Independent Online
SURGEONS have no way of knowing whether they are good or bad at their job compared with others, because too little information is collected on the outcomes of surgery, a senior doctor said yesterday.

James Johnson, the chairman of the British Medical Association's consultants committee, said it was essential that information such as death rates, readmission and re-operation rates was collected to prevent a repeat of the Bristol heart surgery disaster, in which operations on babies were allowed to continue long after it had become clear that too many were dying.

Addressing the BMA's annual conference of consultants, Mr Johnson, a consultant vascular surgeon at Halton General Hospital in Cheshire, said that he could calculate his own mortality rate, but had nothing with which to compare it.

"If I knew that 90 per cent of vascular surgeons in the UK had mortality rates of between 3 and 8 per cent, say, I would be able to see how I was performing compared with my peers."

He said that doctors with poor results could then take action to improve their performance and, where their results were unacceptable, they could be stopped from operating. But in most areas there is no information and no opportunity to compare results.

"Patients find it astonishing that we don't have that data. We have got to get it. But that will mean a huge effort and the Government has got to pay for it."

However, Mr Johnson warned against ranking individual surgeons in league tables of death rates, as is done in the United States.

He said that this could cause them to refuse to operate on risky cases because it might affect their ranking. Instead, an acceptable range should be established and any surgeon who fell within it should be certified; this would indicate that patients could have confidence in them.

"I am a vascular surgeon. If there was pressure on me to improve my ranking in a league table I could refuse surgery to anyone over 75. It already happens in the US. If a patient looks a bit dodgy they have to go out of state [to find a surgeon] because no one wants to operate and risk their place in the league."