Doctors attack mortality rate tables

The publication of the mortality rates of individual surgeons could have a "devastating effect" on the quality of care, leading some to refuse to perform risky operations, senior doctors warned today.

The warning follows the publication of mortality rates by several large NHS trusts, which show that a patient's chance of dying after an operation can be up to seven times higher with some surgeons than with others.

Results from the first trusts to publish their figures, including the Royal Brompton and Harefield, in west London, and Guy's and St Thomas's, in central London, show death rates as high as 8% after all types of cardiac surgery and more than 5% after coronary bypass surgery.

But the figures, released in response to inquiries under the Freedom of Information Act, have been criticised as meaningless because each hospital collates mortality rates using its own criteria to assess the condition of the patient and the risk of surgery.

Sir Bruce Keogh, the president-elect of the Society of Cardiothoracic Surgeons, said the current releases have "jumped the gun" and could place unfair pressure on patients, surgeons and the NHS.

He told the Daily Telegraph: "To present un-risk-adjusted data in the form of a league table is highly irresponsible. It could have a devastating effect.

"It is right and proper that surgeons are made accountable, but this has to be done in a meaningful way. We are morally obliged to protect the public from misinformation, which is what this is.

"The last thing we want to happen is for surgeons to turn down certain operations to preserve their record."

He said the publication of mortality rates in the United States had caused chaos with patients demanding to be treated by high-ranking surgeons who were reluctant to operate in case they tarnished their operating record.

Sir Bruce, who is working with the government to produce a meaningful national performance table, also revealed his fears that surgeons would be deterred from attempting innovative surgery.

Pioneering surgeons with a justifiably high mortality rate would be crucified by the tables and hounded out of their jobs, he warned.

The Royal College of Surgeons said it backed the publication of mortality rates but added that variations in the way the figures were currently compiled meant it was not possible to accurately compare individual surgeons.

A spokeswoman said: "Variables such as case mix and operation risk must be allowed for so that one compares like with like. If this is not done there is a real risk that patients will be misled and surgical teams may be unfairly criticised."