Surgeon league tables under the microscope at scientific meeting

May 10, 2018

The use of surgeon “league tables” to help patients choose their doctor before an operation will be debated at a key medical conference in Sydney today. 

British cardiothoracic anaesthetist Dr Andrew Klein will tell the annual scientific meeting of the Australian and New Zealand College of Anaesthetists that the performance data of 5000 surgeons in the UK has been publicly available as part of a government campaign since 2014.

Dr Klein said while the publication of the data by the National Health Service had been controversial and, in some cases, had led to some surgeons being de-registered, it was a useful tool for patients and their families as it helped them to make informed choices about their operations.

In the UK system surgeon performance is measured against a set of professional standards such as patient survival rates and the number of operations performed.

“There is no doubt that some surgeons believe the publication of this data is unfair because they may stop getting referrals but the availability of this information can have very important implications for patients and patient choice.,” Dr Klein, Chairman of the Department of Anaesthesia and Intensive Care at Royal Papworth Hospital, Cambridge, said.

“Some surgeons have been stopped from working because of the high mortality rates that are published by the NHS. If you fall statistically below what you should be, the NHS or the hospital you’re working in then moves quickly to do something about it.”

“If it was my mother or my wife or any member of my family I would want to know which hospital they are going to and details about the surgeon including their patient mortality rates. For the patient looking at outcomes if the surgeon has nothing to hide then it should be published.”

Dr Klein will be speaking on Reflecting on mortality at the meeting on Thursday May 10.

Dr Klein co-authored a landmark study in 2015 that examined the effect of 127 surgeons and 190 anaesthetists on the mortality of 110,000 cardiac patients over 10 years at 10 UK hospitals. The study concluded that a patient’s health contributes 96 per cent of the risk of death while surgeons accounted for four per cent of the risk. The study found that the hospital where the procedures were performed had no impact and anaesthetists had no effect.

Other factors that are believed to contribute to patient survival rates such as whether the operation was performed in the morning or the afternoon or the day of the operation were found to not have had any effect on cardiac patient survival rates.

Dr Klein said he believed a similar study to the 2015 project could be replicated in Australia.
“It would be worthwhile because then you could look at the variability between surgeons and anaesthetists in Australian hospitals to see whether there are any noticeable differences and then see if it should be reported in the public domain.”

More than 2500 local and international anaesthetists, pain specialists and other medical practitioners have gathered for the scientific meeting at the International Convention Centre in Sydney from May 7-11.
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