This item was published during the term of a previous administration that ended in April 2007
Listen
Surgical mortality rates
06/02/2006
Publishing crude surgical mortality rates by surgeon does not reflect varying difficulties of procedure carried out by different surgeons, Chief Medical Officer Harry Burns said today.
He added that there already was an existing verified audit scheme for surgical mortality in place across NHS Scotland, and that lessons were learned from that.
The data was released by ISD Scotland under the Freedom of Information Act, at the direction of the Scottish Information Commissioner, and is available on the Scottish Health Statistics website.
Dr Burns said:
"As Scotland's Chief Medical Officer - and as a former surgeon myself - I am concerned about how the data might be interpreted.
"It is not possible from these figures to construct a meaningful league table of surgeons. The figures are pretty meaningless unless you know much more about the individual cases taken on by each surgeon. For example, outcome from surgery is strongly influenced by severity of illness and by the presence of other conditions unrelated to the surgical problem.
"Many of those surgeons with the highest mortality rates are the heroes of the health service. They are the last hope of very sick patients. Some of our best, most experienced surgeons take on the very hardest cases.
"They make the difference between life and death. But inevitably, the hardest cases, the sickest patients, have the least chance of survival. Whilst all surgery carries risk, some operations are riskier than others - it is far more risky to operate on blood vessels in the brain than on varicose veins. These figures do not allow proper statistical adjustments for risk to be carried out.
The CMO went on to outline the existing system in place:
"In Scotland, we already have a voluntary audit scheme for surgeons and anaesthetists - the Scottish Audit of Surgical Mortality (SASM). Surgeons can submit a report if a patient dies within their care and: the clinical circumstances surrounding the case are investigated to see whether lessons can be learned.
"Participation rates are very high, and this is encouraging. In most cases, this will allow continued professional development and higher standards of care. In a very few cases, it will let NHS Boards and clinicians see that there is a more fundamental problem, and these are dealt with.
"Surgeons should discuss risk with patients before planned operations. If patients continue to have concerns about outcomes or individual surgical performance, I recommend they ask whether the surgeon participates in SASM and how his or her outcomes compare with colleagues."
Notes to Editors
1. The information referred to has been released today on the ISD website. For further queries on the detail of the data, please contact ISD on 0131 2275 7777.