Surgeons fear being vilified by release of mortality figures


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The Independent Online

There were fears last night about the scapegoating of successful doctors after the public release of surgical mortality data revealed that a third of patients died under the knife of a respected consultant.

The statistics, relating to more than 450 doctors who perform surgery involving blood vessels, were released yesterday morning – the first in a Department of Health bid to “drive better care”.

Before their publication online, Norman Williams, president of the Royal College of Surgeons (RCS), said the publication should not be viewed as a means of “trashing professional reputations”.

Yesterday, one consultant found himself under huge scrutiny and pressure from Health Secretary Jeremy Hunt’s “revolution in transparency”. Simon Payne, a consultant vascular surgeon at Portsmouth Hospitals NHS Trust, was ranked bottom in his field in England.

Mr Payne, who graduated from Leicester University Medical School in 1986 and lists his interests as sailing in the Solent and piano playing, performed elective open abdominal aortic aneurysm (AAA) surgeries.

The procedures, described as “major operations” by the Vascular Society, have an average mortality rate of 4 per cent when patients have open surgery to the abdomen. Those treated by an endovascular repair – a stent graft inserted through the groin – have a 1 per cent mortality rate, on average.

But Mr Payne’s patients, who write on his website of his “lovely way” and relaxing manner, had a mortality rate of 31.3 per cent in 16 surgeries. “It’s ridiculous,” said one of his colleagues yesterday.

Despite repeated attempts, Mr Payne was unavailable for comment. In a statement, Ursula Ward, the trust’s chief executive, said: “This surgeon should not be on the Vascular Registry for this operation as he has not undertaken this form of surgery since 2011.” She added that Mr Payne had stopped performing the surgical procedure after shoulder surgery, adding that his “outcomes fell within the acceptable limit”. By 3pm yesterday the online data had been changed, with Mr Payne’s name removed.

Six surgeons refused to have their data included: Richard Bird, who works for Barnet and Chase Farm Hospitals NHS Trust, Rob Lonsdale from Sheffield Teaching Hospitals, Hull Royal Infirmary’s Peter McCollum, Leszek Wolowczyk from Tameside Hospital, North Manchester General Hospital consultant Manmohan Madan, and Patrick Kent, understood to work at Spire Health in Leeds.

Their reasons for abstention included objections against data quality, the way figures are “risk adjusted”, and opposition to having their data in the public domain. All six perform within the “expected range”, health officials said. The Sherwood Forest Hospitals NHS Foundation Trust has performed relatively few of the AAA operations but has among the highest mortality rates with 14.3 per cent. It has two consultants, Irfan Akhtar and Khalid Makhdoomi, with mortality rates of 22.2 and 12.5 per cent respectively after performing a combined 25 AAAs.

Dr Nabeel Ali, the trust’s medical director, said the figures were  “historical” with the vascular surgical procedures no longer being performed. He said: “The apparently high mortality rates quoted reflect the small number of patients operated upon.”

Speaking yesterday, an RCS source said that the first tranche of data had failed to expose failing surgeons, adding that data published tomorrow and on Monday would be likely to reveal “outlier figures” of unusually high mortality rates.