Surgeon-specific Outcome Data Research Articles

Has Publishing Surgeon-Specific Outcomes Had an Impact on Training in Cardiac Surgery?

Surgeon-specific outcome data are now published for most surgical specialties in the United Kingdom. There are concerns that this initiative has had a negative impact on training. The primary objective of this study was to assess whether training activity has changed since the publication of surgeon-specific outcomes in cardiac surgery. Prospectively collected data for cardiac surgical procedures performed at a single center from 2004 to 2016 were analyzed. The cohort was split into two halves according to operation date. Multivariable logistic regression was used to assess whether training activity had increased from the first to the second part of the study and to identify whether trainee first operator was associated with adverse outcomes. A total of 14,054 cardiac surgical procedures were included, of which 1,777 (12.6%) had a trainee as first operator. Despite an increase in the risk profile of patients undergoing surgical procedures, the proportion of cases performed by trainees increased from 11.7% (786 of 6,708) in the first half of the study to 13.5% (991 of 7,346) in the second half of the study (p= 0.002). This effect remained after adjustment for confounding variables. Trainee first operator was not significantly associated with an increased risk of any adverse short-term outcome. Since surgeon-specific outcome publication began in United Kingdom, cardiac surgical training activity has significantly increased at the study center despite an increase in the risk profile of patients. This study demonstrates that it is possible to maintain or even increase training activity with good outcomes in the era of surgeon-specific outcome publication.

Time to rethink surgeon-specific outcome data for colorectal surgeons in England: Cross-sectional data of 73,842 resections for colorectal cancer

Since 2013, individual surgeon and NHS Trusts outcomes following elective colorectal cancer surgery have been in the public domain in England. The 90-day operative mortality rates following colorectal resections are available for the public to view online. AimThe aim of this study is to evaluate the quality of the published data. It also aims to find whether this data will show the expected pattern of inverse correlation between case volume and the postoperative 90-day mortality rate. MethodologyThe postoperative 90-day mortality data was taken from the Association of Coloproctology of Great Britain and Ireland (ACPGBI) website. Surgeons and Trusts were categorized according to case volume. Completeness of data at Trust and surgeon levels was analysed. All statistical analyses were performed in Statistical Package for Social Science (SPSS, version 23, IBM, Armonk, NY). Results788 colorectal surgeons performed 73,842 resections for colorectal cancer in 143 hospitals over a 5-year period (1st April 2010 and 31st March 2015). The mean national 90-day mortality after colorectal resections was 2.6%. No significant effect was identified when mortality rates were correlated with the surgeon or Trust volume. There was a missing data of 3874 patients in the individual surgeon level analysis when compared to the number of procedures included in Trust analysis (73,842 vs 69,968 cases). About one-third of hospitals (n = 43) had a case ascertainment of less than 90%. Out of the 788 surgeons, there were only two outliers whose mortality rates were outside the “funnel limit”. ConculsionThe expected relationship between case volume and mortality rates could not be established. The completeness of data and low numbers of procedures per surgeon are major concerns. Additional outcome metrics should be utilized to assess performance quality. Failure to Rescue approach should be explored and utilized. It is crucial to have more rigorous and streamlined methods for data collection and case ascertainment to present to the public reliable, complete and relevant data.

The effect of consultant outcome publication on surgeon behaviour: a systematic review and narrative synthesis.

Introduction Surgeon-specific outcome data, or consultant outcome publication, refers to public access to named surgeon procedural outcomes. Consultant outcome publication originates from cardiothoracic surgery, having been introduced to US and UK surgery in 1991 and 2005, respectively. It has been associated with an improvement in patient outcomes. However, there is concern that it may also have led to changes in surgeon behaviour. This review assesses the literature for evidence of risk-averse behaviour, upgrading of patient risk factors and cessation of low-volume or poorly performing surgeons. Materials and methods A systematic literature review of Embase and Medline databases was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Original studies including data on consultant outcome publication and its potential effect on surgeon behaviour were included. Results Twenty-five studies were identified from the literature search. Studies suggesting the presence of risk-averse behaviour and upgrading of risk factors tended to be survey based, with studies contrary to these findings using recognised regional and national databases. Discussion and conclusion Our review includes instances of consultant outcome publication leading to risk-averse behaviour, upgrading of risk factors and cessation of low-volume or poorly performing surgeons. As UK data on consultant outcome publication matures, further research is essential to ensure that high-risk patients are not inappropriately turned down for surgery.

Association of Coloproctology of Great Britain & Ireland (ACPGBI): Guidelines for the Management of Cancer of the Colon, Rectum and Anus (2017) - Follow Up, Lifestyle and Survivorship.

Association of Coloproctology of Great Britain & Ireland (ACPGBI): Guidelines for the Management of Cancer of the Colon, Rectum and Anus (2017) - Follow Up, Lifestyle and Survivorship.

Informed Consent: Impact of full disclosure on public reporting of surgeon specific outcome data

Informed Consent: Impact of full disclosure on public reporting of surgeon specific outcome data

Reporting surgeon-specific outcome data: panacea for everything?

Reporting surgeon-specific outcome data: panacea for everything?

The value of surgeon-specific outcome data: results of a questionnaire.

The publication of surgeon-specific data has been controversial. To assess the profession's opinion, a forum was organized at the 2015 EACTS meeting followed by a questionnaire of the value of surgeon-specific outcome and its impact. A series of presentations were made including assessments of quality and safety in one major European country, the relationship between volume and outcome, the role of guidelines, the effect of publication of results on training, and discussion for and against publication of surgeon-specific data. A questionnaire was given to all attendees at the forum on the value of surgeon-specific data and their impact on the specialty. The questionnaire was completed by 118 attendees. Of the total, 69% felt that mortality is a surrogate for quality and that it should be reported at the hospital and unit level as opposed to the individual surgeon level, but 81% wished there were different criteria for quality outcome. Of the total, 91% felt that the individual surgeons' data should be collected but not published in public portals, and that publication produces risk-averse behaviour; 65% felt that it hinders innovation; 86% felt that EuroSCORE II is not reliable in identifying high-risk patients and the same number felt that it has affected entry into the specialty. The information that is collectable will be published, but we can control the way in which it is published and presented.

Understanding The Strengths And Weaknesses Of Public Reporting Of Surgeon-Specific Outcome Data.

Public reporting of outcome data is increasingly being used at the institutional and clinician levels and has become mandatory in some parts of the United States and the United Kingdom. The intended benefits are to drive quality improvement, demonstrate transparency, facilitate patient choice, and allow identification of poor performance. Public reporting of surgeon-specific mortality data, however, may have unintended consequences that include causing surgeons to become risk-averse, discouraging innovation, having an impact on training, and prompting "gaming" in health care. Given the small number of some surgical operations performed by individual surgeons, such data are unlikely to identify outliers or poor performers in a valid way. If metrics are deemed necessary and required to be reported publicly, they should be procedure specific; account for sample size; and focus not solely on mortality but also on other outcomes such as quality of life, patient satisfaction, and experience.

PTH-353 Surgeon specific outcome data in colorectal cancer surgery - the patient perspective

Introduction NHS England requires trusts to report individual outcomes in ten clinical specialties. In September 2013, the Association of Coloproctology of Great Britain and Ireland (ACPGBI) published individual surgeon and hospital outcomes detailing 90-day mortality rates after elective resection for bowel cancer. This data is available to view online. Our aims were to investigate patients’ awareness and perspective of surgeon specific outcome data and to find out what was important to them about their upcoming operation. Method Over a 6 month period, all consecutive patients attending preoperative assessment prior to resection for colorectal cancer at a teaching hospital were asked to complete the survey. Results Of the 67 patients asked to complete the survey 66 (98.5%) responded. 13 of 66 (20%) patients stated they were aware of the surgeon specific outcome data and of those, 6 said they would know how to find it. 52 (79%) patients said the surgeon was more important than the hospital, 9 stated the hospital and 5 were undecided. When asked about other factors, 41 (67%) stated the reputation of the surgeon was the most important. Only 2 patients chose surgeon specific mortality rate, 18 said the number of times the operation had been performed by the surgeon in the preceding year and 5 did not answer the question. Conclusion Most patients undergoing surgery for bowel cancer are unaware of the published outcome data for their surgeon. Of those that are aware less than half would know how to find it. However the overwhelming most important factor for the patient is the perceived reputation of the surgeon. Disclosure of interest None Declared.

PWE-267 Has the publication of surgeon specific data adversely affected older patients?

Introduction The Association of Coloproctology first published surgeon specific outcome data in September 2013. There has been some concern this may lead to surgeons refusing to operate on higher risk patients. Furthermore, Published by the Royal College of Surgeons of England, “Access Ages 2” suggests that there is a marked decline in rates of elective surgery in over 65s. It described a 9 fold difference in the rate of colorectal cancer excision for over 75s depending on where the patient lives. We hypothesised that concern over poor outcomes may lead to a reduction in the age of patients offered elective colorectal cancer excision. Method Data was prospectively collected on all patients undergoing elective colorectal cancer resections in our unit. We compared the patient selection for one year before and after publication of surgeon specific data. Results In the 12 months prior to publication of surgeon specific data, our Unit (4 Consultant Colorectal Surgeons) operated on 114 patients with a median age of 71 (IQR 63–77.5), compared to 84 patients with a median age of 72.5 (65–77) for the subsequent 12 months (p = 0.351, Mann-Whitney). There were more patients in the 75–85 age range than in the 65–75 range. The comorbidities identified in both groups were comparable. Conclusion There was no difference in the age group of patients offered elective surgery following the publication of surgeon specific outcome data. Fears that the publication may lead to older patients being denied surgery were unfounded. Disclosure of interest None Declared. Reference http://www.rcseng.ac.uk/news/docs/access-all-ages-2

OC-058 A survey of surgeon specific outcome data and their potential impact on surgical training

Introduction The publication of surgeon specific data (SSD) for general surgeons at the end of 2013 started a new era in surgery in the UK. It is not known if and how this will impact surgical practice and training particularly with respect to high-risk cases. We aimed to explore the consultants’ perception and their potential changes in their practice as a result of SSD publication. Method A cross sectional on-line survey was sent to a sample of General Surgeons with an interest in Upper GI surgery. Details of their current surgical practice and their opinions on the changes they would make in clinical practice and training were collected. Questions were themed and data analysed both qualitatively and quantitatively. Results Eighty nine surgeons responded to the questionnaire. Of those 61 (68.5%) were cancer surgeons and 28 (31.5%) described themselves as a benign (including bariatric) surgeon. Thirty six (40%) surgeons considered SSD to be of no benefit at all to surgical training while 21 (23.5%) thought there will be some useful effect. Asked whether there was any negative effect on training, 33 surgeons (37%) thought there will be a detrimental effect on surgical training in general, and 25 (75%) of those thought this effect will be mainly on complex cases. However, when asked to specify the negative effects on surgical training 55 (73%) of the group said the number of complex operations done by trainees will drop and 35 (46%) thought the number of all operation done by trainees will drop. A significant point was the attitude toward trainees where 32 (36%) surgeons said they will perform major or complex cases themselves with 13 (14%) choosing the option of performing all cases themself. Upon asking about any general changes to practice, 11 (12.5%) said they will give up or reduce high risk surgery and 32 (36%) thought their practice will not change. Regarding the patients’ outcome 49 (55%) thought that SSD will improve outcomes while 40 (45%) answered that they will not change outcomes. Qualitative assessment, using content analysis technique, showed a minority of the surgeons will either avoid training their trainees in high risk patients and/or avoid high risk cases in order to maintain their SSD data reputation. Conclusion The publication of surgeons’ specific data will result in some changes to general surgical practice. It is too early to decide whether these effects are good for training, however, if these initial opinions are applied to routine practice then trainees may be faced with large scale reductions in training cases particularly those of a complex nature that would have major ramifications on surgical training. As the shape of surgical training continues to be developed it is important that the implications of SSD on surgical training are considered. Disclosure of interest None Declared.