Surgeon specific mortality in adult cardiac surgery

Editor—I fully support the use of risk stratified mortality data in preference to crude mortality data if surgeon specific comparisons are to be published. The quality of such information depends on the rigour with which data are collected. Bridgewater et al took great care to ensure completeness and accuracy of data, including prospective collection of data, such that only 2% of data were missing. This adds considerable weight to their conclusions.¹

If such methods are to be used nationally, there must be equally robust validation of the data collection process in all institutions to prevent potential information bias. There is a danger that data will be collected retrospectively, and the investment in, and quality of, coding and record keeping varies greatly between institutions. For example, the absence of data on comorbidities or the failure to code them will result in a low estimate of expected mortality and falsely suggest a poorer surgical performance.

Should this approach be adopted, robust evidence of data completeness and accuracy should be a prerequisite before data are accepted from any institution to ensure that surgical performance is being compared, not administrative capacity.