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Updated: Jun 2, 2026

Subcostal Specimen Removal in Completely Portal Robotic Lobectomy
04:38

Subcostal Specimen Removal in Completely Portal Robotic Lobectomy

Published on: April 19, 2024

Hospital mortality under surgical care.

O Aziz1, D Fink, L Hobbs

  • 1Department of Surgery, Lister Hospital, Stevenage, UK.

Annals of the Royal College of Surgeons of England
|April 12, 2011
PubMed
Summary
This summary is machine-generated.

Hospital performance metrics using hospital standardised mortality ratio (HSMR) may be inaccurate. A review found significant coding errors in patient data, questioning the reliability of HSMR for assessing surgeon performance.

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Last Updated: Jun 2, 2026

Subcostal Specimen Removal in Completely Portal Robotic Lobectomy
04:38

Subcostal Specimen Removal in Completely Portal Robotic Lobectomy

Published on: April 19, 2024

Area of Science:

  • Healthcare Performance Measurement
  • Medical Statistics
  • Surgical Outcomes Analysis

Background:

  • The hospital standardised mortality ratio (HSMR) is a key performance indicator for NHS hospitals in England.
  • Recent criticisms highlight significant variations in HSMR, questioning its validity as a sole performance measure.
  • This study examines the accuracy of HSMR data for a consultant general surgeon.

Purpose of the Study:

  • To review mortality data for a consultant general surgeon over three years.
  • To evaluate the accuracy of diagnosis and covariate coding used in HSMR calculations.
  • To assess the reliability of clinician-specific mortality data for performance evaluation.

Main Methods:

  • Utilized the Dr Foster Intelligence database to extract HSMR benchmark data for inpatient mortality.
  • Focused on data for a specific consultant general surgeon from April 2006 to March 2009.
  • Compared extracted HSMR data against original hospital patient records.

Main Results:

  • Identified 30 patients; 12 (40%) were incorrectly attributed to the surgeon.
  • Of the 18 correctly attributed patients, co-morbidity data (Charlson index) was recorded for only 27% (operative) and 43% (non-operative) despite 94% having significant co-morbidities.
  • Indicates substantial inaccuracies in attributing consultant responsibility and recording case-mix adjustment data.

Conclusions:

  • Clinician-specific mortality data, as used in HSMR, can be crude and inaccurate.
  • The potential for misrepresentation is high, especially when avoidable adverse events constitute a small percentage of deaths.
  • Relying on such data for performance assessment may be irresponsible and misleading.