The legacy of Bristol: public disclosure of individual surgeons' results

Keogh, Bruce; Spiegelhalter, David; Bailey, Alan; Roxburgh, James; Magee, Patrick; Hilton, Colin J.

doi:10.1136/bmj.329.7463.450

Cited by 75 publications

(49 citation statements)

References 22 publications

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“…In the NHS cardiac surgeons have led the way [11][12][13] in the wake of well-publicised failures of surgical care. The advent of electronic patient records for routine collection of detailed standardised data items brings fresh opportunities for in depth analysis of specific outcomes including risk indicators for adverse outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…9 Transparency of medical and surgical outcomes has become a matter of public concern, with the medical director of the NHS having indicated a clear expectation that in the future the clinical outcomes of individual surgeons will be placed in the public domain. 10,11 The issue is therefore no longer whether this will or will not occur, it is now a question of which form it should take. Risk adjustment of outcomes for case complexity has been in use in cardiac surgery for a number of years.…”

Section: Introductionmentioning

confidence: 99%

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The cataract national data set electronic multi-centre audit of 55 567 operations: case-mix adjusted surgeon's outcomes for posterior capsule rupture

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The cataract national data set electronic multi-centre audit of 55 567 operations: case-mix adjusted surgeon's outcomes for posterior capsule rupture

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et al. 2011

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“…The Society of Cardiothoracic Surgeons worked hard to collect validated, risk-stratified data within this timeframe 2 and by 2003 individual units began publishing their own risk-stratified data. 3 Be it due to inadequate data collection or reluctance of individual hospitals or surgeons, by 2004 only a mix of incomplete raw and risk-stratified data was available, with many units refusing to make even this publicly accessible.…”

Section: Ann R Coll Surg Engl (Suppl) 2006; 88:280-283mentioning

confidence: 99%

Will performance league tables change the way surgeons select and operate on patients?

2006

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“…[1][2][3] Approximately a quarter of cataract surgery in the NHS is, however, undertaken by trainees at specialist registrar (SpR) level, 4 which amounts to around 75 000 operations annually in England alone. It is accepted that posterior capsule rupture (PCR) rates for learners are higher than those for experienced phacoemulsification surgeonsFan unsurprising finding.…”

mentioning

confidence: 99%

Cataract surgery: benchmarks for established and trainee surgeons

Sparrow

2008

Eye

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Much attention is currently focused on surgical outcomes, with policy clearly in favour of the publication of individual results for consultant surgeons.1-3 Approximately a quarter of cataract surgery in the NHS is, however, undertaken by trainees at specialist registrar (SpR) level, 4 which amounts to around 75 000 operations annually in England alone. It is accepted that posterior capsule rupture (PCR) rates for learners are higher than those for experienced phacoemulsification surgeonsFan unsurprising finding. 5,6 With this number of procedures being undertaken in the NHS by trainees, it is a matter of public health relevance to know what complication rates should be expected for this group of training surgeons.A recent electronic audit of 55 567 cataract operations identified an overall PCR rate of 1.92% for 406 surgeons of all grades working in the English NHS.4 Analysis of risk factors for PCR revealed surgeon's grade to be an important determinant of complication risk. 7Trainees at SpR level were 65% more likely to have a complication than consultants, after adjustment for other risk factors. A major determinant of PCR risk was case complexity, patients with multiple risk factors being at a strikingly increased risk of a complication as predicted by the logistic regression model. A male patient aged above 90 years with diabetic retinopathy and a brunescent cataract, for example, would have a predicted probability of a PCR of 10% if operated on by a consultant, but around 16% if operated on by an SpR. This difference in predicted probability of a complication of 6% between the surgeons makes a strong case for such higher risk patients being operated on exclusively by consultants.In this issue Buchan and Cassels-Brown 8 have provided information on surgical opportunities, and surgical complication rates for trainees at SpR level in the Yorkshire region. Surgical opportunities appeared adequate in this sample of trainees, and assuming representativeness, the finding bodes well for the training opportunities of the next generation of consultant ophthalmologists. The overall PCR rate for the 19 participating trainees of 2.3% is also reassuring. Without information on surgical case mix, however, the full picture remains uncertain. If the case mix complexity of these trainee surgeons was such that they operated exclusively on the lowest risk patients, then from the logistic regression model noted above, 7

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The legacy of Bristol: public disclosure of individual surgeons' results

Abstract: Measurement of outcomes from medical or surgical interventions is part of good practice, but publication of individual doctors' results remains controversial. The authors discuss this issue in the context of cardiothoracic surgery

Cited by 75 publications

References 22 publications

The cataract national data set electronic multi-centre audit of 55 567 operations: case-mix adjusted surgeon's outcomes for posterior capsule rupture

The cataract national data set electronic multi-centre audit of 55 567 operations: case-mix adjusted surgeon's outcomes for posterior capsule rupture

Will performance league tables change the way surgeons select and operate on patients?

Cataract surgery: benchmarks for established and trainee surgeons

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