Mortality rates not reliable measure of surgeon performance, study finds

Publishing the patient death rates of individual surgeons could be giving patients a false sense of physician ability, according to new research.

A study published in BMJ Open suggests mortality rates are too unrefined to detect physicians who may actually put patients at risk. The researchers analyzed individual surgeons' caseload for three common high-risk procedures and three common low-risk procedures from 2010 to 2014 in England, looking in particular to see how well this data could predict if the surgeon had a patient death rate between two and five times the national average.

They found case load rendered mortality rates statistically insignificant for most physicians. In fact, they wrote that most surgeons could not perform enough procedures in their entire career for the data to show a patient mortality rate five times the national average.

Take bowel surgery for example. The researchers found surgeons performed an average of 55 bowel surgeries within three years, though actual surgery counts ranged from three to 237 per physician within a three-year period. The average national 90-day death rate for bowel surgeries in England is 3 percent. Using the national average case load of 55 surgeries, the researchers determined this provides 20 percent "statistical power" to find surgeons with a mortality rate of 9 percent, or three times the national average. Statistical power indicates the reliability of the measure. In the case of bowel surgeries, 20 percent statistical power means out of 100 surgeons whose death rates are three times the national average, data for just 20 would reflect this.

To make bowel surgery a 90 percent reliable predictor of mortality rate, a surgeon would have to perform more than 200 surgeries every three years, according to the study.

"This analysis demonstrates that, for these common procedures, mortality rates are not a robust method for detecting divergent practice. It is not surprising that the performance of all but one surgeon across all six procedures was found to be acceptable," the authors wrote, according to a press release.


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