Risk-adjusted analysis of surgeon performance: a 1-year study

Area of Science:

• Surgical Quality Assessment
• Health Services Research
• Patient Safety

Background:

• Surgeon performance evaluation is crucial for maintaining high standards in healthcare.
• Traditional methods of comparing surgeon outcomes using raw mortality and morbidity rates can be misleading.
• The need for a more objective and risk-adjusted system for assessing surgical quality is evident.

Purpose of the Study:

• To evaluate the reliability of raw mortality and morbidity statistics for comparing individual surgeon performance.
• To introduce and assess the utility of the Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM) scoring system in quality assessment.
• To demonstrate an improved method for monitoring surgeon performance and identifying potential disparities.

Main Methods:

• A 1-year prospective analysis of non-day-case general surgery patients (n=3004) in a district general hospital.
• Application of the Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM) scoring system to assess patient risk.
• Calculation of the observed to expected (O:E) ratio for mortality and morbidity for each surgeon to adjust for patient complexity.

Main Results:

• Raw mortality rates varied significantly (1.0-4.9%), but O:E ratios showed a narrower range (0.83-1.06), indicating risk adjustment is necessary.
• Morbidity rates also demonstrated considerable variation (5.3-12.6%), with O:E ratios ranging from 0.86-1.02.
• The study highlights the potential for significant misunderstanding and misinterpretation of 'league tables' based on uncorrected data.

Conclusions:

• Raw mortality and morbidity data are inadequate and potentially hazardous for comparing surgeon performance.
• The POSSUM scoring system and O:E ratios provide a more accurate and equitable method for monitoring surgical quality.
• Accurate monitoring of surgeon performance is essential to avoid misinterpretations and ensure patient safety.