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Related Experiment Videos

Identifying under-performing surgeons.

R Singh1, N Smeeton, T S O'Brien

  • 1Department of Urology, Guy's Hospital, London, UK.

BJU International
|June 5, 2003
PubMed
Summary
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Distinguishing surgical under-performance from chance requires large patient cohorts. While consecutive deaths are rare for competent surgeons, clustered deaths can occur, highlighting the need for careful statistical analysis in surgical outcomes.

Area of Science:

  • Medical Statistics
  • Surgical Quality Assessment
  • Health Services Research

Background:

  • Assessing surgical performance is crucial for patient safety and quality improvement.
  • Differentiating genuine under-performance from random variation in outcomes is a statistical challenge.
  • Radical cystectomy for bladder cancer has significant implications for patient survival.

Purpose of the Study:

  • To determine the sample size needed to statistically confirm surgical under-performance.
  • To evaluate the probability of consecutive or clustered deaths in surgical series.
  • To assess the likelihood of achieving excellent results by surgeons with varying competence levels.

Main Methods:

  • Theoretical analysis of 30-day mortality rates following radical cystectomy.

Related Experiment Videos

  • Defined surgical competence (4% mortality), excellence (2% mortality), and under-performance (8-40% mortality).
  • Explored four scenarios: sample size for proving under-performance, likelihood of consecutive deaths, likelihood of clustered deaths, and likelihood of outstanding results.

    • Main Results:

    • Sample sizes of 7 to 211 cases are required to prove under-performance, depending on the mortality rate.
    • Consecutive deaths are rare (<2% for competent surgeons), but clustered deaths (2 in 10 cases) are plausible for competent surgeons (5%) and likely for under-performing ones (23%).
    • Achieving no deaths in 40 cases is highly unlikely for surgeons with mortality rates of 8% (3.6%) or higher (<1%).

    Conclusions:

    • Confirming significant surgical under-performance necessitates very large patient cohorts.
    • Analysis of consecutive or clustered deaths offers limited sensitivity in identifying under-performing surgeons.
    • Observing no deaths in 40 consecutive cases strongly suggests surgical competence.