Publicity ‘has not ended risky surgery

Study examined impact of death rates

HEALTH: Publishing patient death rates for individual bowel cancer surgeons in England has not led to “risk averse” behaviour or fudged statistics, a study has found.

Research found publication of the information did not spook medics into being over-cautious when deciding whether to operate on high-risk patients.

PUBLISHING PATIENT death rates for individual bowel cancer surgeons in England has not led to “risk averse” behaviour or fudged statistics, a study has found.

Research found that the publication of the information as part of an NHS transparency drive did not spook medics into being overcautious when deciding whether to operate on high-risk patients. The study, published in the

British Medical Journal (BMJ) found that making the data available actually coincided with a “substantial” reduction in death rates among patients who had non-emergency surgery.

Fears were raised over the effect of the extra scrutiny of medics after the NHS began publishing surgeon-specific bowel cancer operation death rates in 2013, a move designed to drive up standards of care.

Professor Derek Alderson, President of the Royal College of Surgeons, said: “There has been concern in some quarters that reporting the outcomes of individual surgeons could discourage some from offering surgery to high-risk patients.

“Today’s study is reassuring as it did not find any evidence of risk-averse patient selection following the introduction of public reporting of outcomes after bowel cancer surgery.

“The fact that surgical mortality decreased significantly following the public reporting of individual bowel cancer surgeons’ outcomes further underlines the importance of a culture of transparency and openness in improving the overall care of patients.”

The study examined data from more than 111,000 patients to see if any change was noticeable since mortality rates became public.

A team of UK researchers, led by Kate Walker from the London School of Hygiene and Tropical Medicine, looked for evidence of cautious behaviour and data manipulation immediately before and after the introduction of surgeon specific reporting in the NHS in England.

They found that the proportion of patients with bowel cancer who had major surgery did not change significantly following the move.

Some 63.3 per cent of patients had surgery before the change, while 63.2 per cent did afterwards.

The study also found that a “significant” reduction in deaths among patients in the 90 days following non-emergency care coincided with the introduction of public reporting.

But the researchers said it was not possible to say one was caused by the other.

Similar improvements were not found for emergency surgery, which is not subject to the mandatory reporting guidelines.

The study authors said their report provides “unique evidence” that the introduction of mortality reporting did not lead to changes in they way high-risk patients were selected for bowel cancer surgery.

The study underlines the importance of transparency. Professor Derek Alderson, President of the Royal College of Surgeons.