Risk-adjusted analysis of surgeon performance: A 1-year study

Author:

Copeland G P1,Sagar P1,Brennan J1,Roberts G1,Ward J1,Cornford P1,Millar A1,Harris C1

Affiliation:

1. Warrington Hospital NHS Trust, Lovely Lane, Warrington, Cheshire WA5 1QG, UK

Abstract

Abstract A 1-year prospective analysis was undertaken of all non-day-case general surgery in a district general hospital. Using the Physiological and Operative Severity Score for the en Umeration of Mortality and Morbidity (POSSUM) scoring system 3004 patients were assessed. From the predictions of mortality and morbidity so obtained, a quality measure, the ratio of observed to expected numbers of deaths and complications (O:E ratio) was determined for each surgeon, both overall and within specialty zones. The present study demonstrates the serious hazard in using ‘raw’ uncorrected mortality and morbidity statistics to compare surgeon performance. Mortality rates varied from 1·0 to 4·9 per cent whereas O:E ratios ranged from 0·83 to 1·06; morbidity rates varied from 5·3 to 12·6 per cent with O:E ratios 0·86-1·02. Great misunderstanding may result from the publication of surgeon or hospital ‘league tables’. The present study demonstrates a technique that might allow surgeon performance to be monitored adequately and accurately.

Publisher

Oxford University Press (OUP)

Subject

Surgery

Reference12 articles.

1. The double edge of knowledge;Berwick;JAMA,1991

2. Impact of variability among surgeons on postoperative morbidity and mortality and ultimate survival;McArdle;BMJ,1991

3. POSSUM: a scoring system for surgical audit;Copeland;Br J Surg,1991

4. Identification of patients at greatest risk for developing major complications at cardiac surgery;Hammermeister;Circulation,1990

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