Heart surgery death rates published

Twenty-five surgeons from north-west England publish their individual mortality rates for heart operations today, setting a precedent for other doctors who are under pressure from the public to reveal their results.

The surgeons say they hope their move will promote openness and transparency within the NHS.

Their figures, they say, show that all the surgeons are performing to satisfactory standards.

Surgeons have been moving towards the publication of individualised results since the Kennedy inquiry into deaths among babies undergoing heart operations at the Bristol Royal infirmary between 1984 and 1995.

Two surgeons and the chief executive were disciplined by the General Medical Council when it emerged that the death rates were higher than at comparable hospitals. But the process has been slow.

The government hoped that individualised results would be available for all heart surgeons by last year.

In today's British Medical Journal, Ben Bridgewater, consultant heart surgeon at South Manchester University hospital, and colleagues in the north-west group, point out that Dame Janet Smith at the Shipman inquiry said the GMC could be criticised for putting the interests of doctors ahead of patients.

"Surgeons have been criticised as leaning too far towards protecting the reputations of surgeons," they add.

But they say it is important that publication of results should not engender a culture where surgeons avoid operating on the most difficult cases.

The north-west group offers a solution. As well as a crude death rate - the percentage who died - they have split the total number of operations carried out by each surgeon into high and low risk cases using a system of points for potential problems, such as old age and a heart in poor condition.

They looked at three years of data on two benchmark operations, the coronary artery bypass graft (CABG) and the aortic valve replacement (AVR).

They found that 17% of the patients undergoing a bypass and half having a valve replacement were considered high risk.

The overall death rate for all CABGs was 1.8% and for all AVRs was 1.9%. But if split between high and low risk, it became clear that more deaths were in high-risk cases.

Average mortality in low-risk CABG operations was 1% and in AVRs it was 0.9%.

The results are good compared with the national average.

"Patients in north-west England will now be able to scrutinise an individual surgeon's comparative outcomes and this should provide reassurance about overall quality and give the ability to exercise choice of surgeon," they write. But, they say, they would argue the results give no reason for a patient to choose one surgeon in preference to another, because all are acceptably good.

Mr Bridgewater said yesterday that low death rates were not just due to the quality of the surgeon.

"Good results in cardiac surgery come from good systems of care," he said.