Public reporting of death rates doesn't catch poor performance

In England, new research published in the journal The Lancet shows that publication of death rates for individual surgeons is not likely to correctly identify poorly performing surgeons for certain specialties, specifically because low numbers of key operations performed don't lead to reliable results.

"Our study reveals that although mortality rates may reflect the performance of individual surgeons for some procedures like cardiac surgeries which are performed more frequently, they may be far less effective for other procedures such as bowel cancer resection which is done less commonly," Jenny Neuburger, Ph.D., a researcher from the London School of Hygiene & Tropical Medicine who carried out the research, said in the announcement.

"The danger is that low numbers will mean that chance factors overwhelm the influence of surgeon performance on the number of deaths. This could mask poor performance and lead to false complacency."

For example, researchers estimated for bowel cancer surgeries, to get even 60 percent accuracy on performance, the annual median number of surgeries would need to be ten times higher.

The study concludes, "We recommend use of outcomes that are fairly frequent, considering the hospital as the unit of reporting when numbers are low, and avoiding interpretation of no evidence of poor performance as evidence of acceptable performance."

To learn more:
- see the study (subscription required)
- see the research announcement

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