Editor—The Commission for Health Improvement recommends that NHS trusts undergo risk assessment so that potential weaknesses can be identified under the health Act 1999. A private company produced a risk assessment for our trust that included a table for the top 10 consultant surgeons by volume of complications. Clinicians immediately raised serious concerns about the accuracy of this risk report and possible over-reporting of complication rates.
We independently reviewed the data and studied the reported complications of two consultant orthopaedic surgeons in the top 10. We compared published complications with the medical diagnosis in the patient notes. Data were produced on 143 reported complications. We identified serious inaccuracies in the report with the actual complication rate being much lower than the reported rates (table).
Table 1.
Complication rates (%) for two consultants
| Complication rate | Consultant 1 | Consultant 2 |
|---|---|---|
| Published | 13.9 | 10.3 |
| In peer group | 5.8 | 5.8 |
| Assessed independently (actual rate) | 2.3 | 2.1 |
The risk assessment was based purely on the ICD-10 coding provided on patients' discharge. Codes are used to flag complications regardless of their context. Surgeons who revise failing joint prostheses are labelled as having had complications irrespective of the time that has elapsed since the initial replacement and the original surgeon. Coded data on complications were often incorrect, and, worryingly, these incorrect data can be interpreted and used to form league tables that do not reflect actual practice.
Clinicians need to become increasingly involved in coding such that validation of data occurs. The involved clinicians were not consulted at any point during the production of the risk assessment document and being incorrectly labelled a consultant in the top 10 by volume of complications could be extremely damaging. We recommend that before performance reports are published clinicians must be consulted so that the potentially serious consequences of incorrect reporting are limited.
Competing interests: None declared.