Ten vascular surgeons to have safety review

Scrubbing in Image copyright Thinkstock

Ten vascular surgeons are to have their work reviewed to investigate whether they have been performing operations at an acceptably safe level.

This follows the path-breaking publication of data on death rates for individual hospital consultants who conduct surgery on major blood vessels.

Last week I wrote about the fact that several surgeons were now to be flagged with an "alert" within the vascular surgery monitoring system.

Following corrections to the initial dataset which contained some errors, we now know an alert will be raised for seven surgeons due to their comparatively bad record on repairing abdominal aortic aneurysms, a highly dangerous bulge in the aorta.

Another three vascular surgeons will receive an alert flag due to their poor results on a different procedure, to correct the narrowing of an artery in the neck (carotid endarterectomy).

It is not possible to identify with certainty who the surgeons are. This decision to scrutinise the work of those with the worst record is based on data which is risk-adjusted (and unpublished), not on the raw figures for mortality rates which have been released for each consultant.

And I can reply to some of the issues that were raised in the comments on my previous piece.

It is correct to say that the data only covers planned surgery, not emergency operations which naturally have much higher death rates.

As I have noted, the individual figures for each surgeon are not risk-adjusted, but the data used in the graphs which compare surgeons is. The adjustment is based on the patients' age and gender and the surgical procedure. Due to gaps in the data it did not reflect the patients' conditions.

Some vascular surgeons are very uneasy about the reliability of the risk-adjustment process, but the Royal College of Surgeons Clinical Effectiveness Unit maintains that this model works well. There are plans to improve data collection and risk-adjustment in future.

The policy on the threshold for when an alert should be triggered, and a surgeon's work reviewed, is set by the Royal College of Surgeons and the Vascular Society.

It is also worth noting that death rates for surgery on abdominal aortic aneurysms have improved considerably in the past few years. This follows a concerted quality improvement drive by the Vascular Society after a 2008 report which found that the UK's record then was poor compared to many other European countries.

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