Published death rates may distort work of Scottish surgical “heroes”

Mortality data have been published for every surgeon in Scotland for the first time, leading to concern about how the public might interpret the information.

The health service in Scotland has been forced to publish the data under freedom of information legislation. Two newspapers had successfully appealed a decision by the Scottish health service to refuse to make the information public (BMJ 2005;331: 142416356963).

The information, which was made available on a website earlier this week, relates to around 1000 surgeons. It lists their name, specialty, the type of admission (elective or emergency), and the number of deaths of patients and calculates an overall death rate. Data are provided for three years up to March 2005. Unsurprisingly, the highest rates are for emergency cases, with very few deaths occurring in elective procedures.

Strong warnings about inappropriate use of the information have accompanied its publication. The website says that such data are routinely provided to health professionals to assess treatment outcomes. They can use their knowledge of the cases and the local healthcare system to help improve the safety and quality of surgical care. “Taken out of context and without this background information, these figures do not provide reliable information about surgical performance,” it adds.

Scotland's chief medical officer, Harry Burns, a former surgeon, said he was concerned about how the data might be interpreted. He said, “The figures are pretty meaningless unless you know much more about the individual cases taken on by each surgeon. Many of those surgeons with the highest mortality rates are the heroes of the health service. They are the last hope of very sick patients. Some of our best, most experienced surgeons take on the very hardest cases.”

Graham Teasdale, chairman of the Scottish Audit of Surgical Mortality and president of the Royal College of Physicians and Surgeons of Glasgow, said there was a difference between information and knowledge. The crude data published this week provide information, but the lack of context means they add nothing to our knowledge, he said.

Under the Scottish audit scheme, deaths of patients occurring during surgery or anaesthesia are investigated. As a result, mortality in elective surgery has halved and that in emergency cases has fallen by a third in Scotland in the past 10 years.

Professor Teasdale said, “Surgeons have no quarrel with information being made available, but this is pretty incomprehensible. It may be that it could be developed further, but is that the best way to use the time and effort? The real way to improve outcomes after surgery is to give governance, safety, and quality a much higher place than things like waiting lists targets in the priorities set for managers.”

The chairman of the BMA's Scottish Consultants Committee, Clive Davis, said it was wrong to single out doctors when publishing mortality data. “The majority of a consultant's work is carried out as part of a multidisciplinary team, therefore information on outcomes should also be available by team.”