By the way... How to tell if your surgeon is any good

DOES knowing how many patients have died under a surgeon’s knife reveal how good — or bad — they are at their job?

Instinct tells you yes, but recent research from the University of Edinburgh suggests that, in fact, death rates for individual surgeons are not a reliable indicator of their performance.

Patients need full information about the treatment they’re about to undergo, and transparency is essential when providing that advice, not least when the patient is being asked to sign a consent form before their operation — ‘transparency’ in this instance meaning knowing the potential risks, not just the benefits.

However, the details of surgeons’ death rates, which have been published online for the past three years for a range of procedures including heart and orthopaedic surgery, aren’t a good way to assess their skills. One of the problems is that we simply don’t yet have a way to properly measure an individual’s performance — currently, a system used for predicting mortality rates in hospitals after surgery and where the patient is in intensive care is being used increasingly to measure actual mortality rates.

But while this tool might help identify how well a hospital is doing, it’s not sophisticated enough to assess an individual surgeon’s results — it’s a technical thing, but put simply, each individual surgeon does not perform enough procedures for this tool to work in this way.

Furthermore, survival following major surgery depends upon far more than just the skills of the surgeon: diagnosis, pre-operative investigations, anaesthesia, post-operative care, whether it’s elective surgery or an emergency procedure — they all affect the progress, or otherwise, of the patient. We need a better mechanism to monitor given procedures under the care of a particular surgeon — but also new measures for assessing their performance in other areas, such as communication and patient satisfaction, which are also vital skills in good care.

The worry is that, if we continue on the present track of (flawed) analysis of mortality rates alone, surgeons may step back from taking on the more difficult cases, becoming risk averse and selective about who they will operate on (to improve their figures).

That would be a poor direction for surgical care to take, with overweight patients, smokers, those with a history of heart disease, or others who present far greater surgical risks finding themselves turned down for treatment and left to their fate. We should be concerned.

And, in the meantime, take mortality figures for individual surgeons with a pinch of salt.