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Last Updated: Friday, 14 January, 2005, 01:31 GMT
Death data 'cuts risky surgery'
Surgeons
Doctors fear mortality data could be misread
US heart specialists are not carrying out risky but potentially life-saving treatments because they could 'skew' their death rate, a study suggests.

A University of Rochester survey in Archives of Internal Medicine found nearly 80% of cardiac surgeons in New York State had avoided risky surgery.

UK heart surgeons do publish mortality rates for units.

But they fear individual data would give an incorrect picture, as the best surgeons handle the most risky cases.

The cardiologist must decide whether to perform a procedure that is possibly life-saving for the patient at the risk of making their own statistics will look worse
Dr Craig Narins, University of Rochester
Other surgical specialties have not yet published such data.

The government is still pushing for more detailed data to be published, but surgeons are continuing to resist the move.

The US study looked at decisions regarding a patient's suitability for an angioplasty, a procedure where a clogged artery is unblocked.

If the patient receives necessary angioplasty, but ultimately dies from their illness, that death still shows up on the cardiologist's record and that of their unit in cardiac mortality data.

Of the 120 physicians who responded to the survey, the vast majority agreed or strongly agreed that the publication of mortality statistics has, in certain instances, influenced their decision regarding whether to perform angioplasty on individual patients.

The researchers identified an increased reluctance among the surgeons to carry out the procedure on critically ill patients even though these patients may have the most to gain from angioplasty.

It found 79% said decisions they had made about accepting critical cases into their angioplasty clinics had hinged on how the outcome would affect their state mortality data report card.

'Conflict'

New York is one of the few US states which publishes mortality data to tell patients how their doctors are performing.

The system is designed not to penalise doctors as much when a seriously ill patient dies following a procedure, but 85% of those surveyed believed that the risk adjustment model used in New York is not sufficient to avoid punishing physicians who perform higher-risk interventions.

Dr Craig Narins, who carried out the research, said: "While these reports attempt to provide the public with objective information about physician quality, they can in some instances create a conflict for the physician that may actually worsen patient care.

"The cardiologist must decide whether to perform a procedure that is possibly life-saving for the patient at the risk of making their own statistics will look worse."

James Roxburgh, honorary secretary of the UK's Society of Cardiothoracic Surgeons for Great Britain and Ireland, said: "This is in line with other papers which have come out of the States from cardiac surgeons showing these report cards can lead to high-risk avoidance practise.

"That's been the concern if you release surgeon-specific data."

Mr Roxburgh added: "The important thing is to educate the public and patients that it's not just the surgeon who determines the outcome of an operation.

"There are many factors, such as the patient themselves, the other people who look after the patient and intensive care unit infection rates."


SEE ALSO:
Heart op death rate 'improving'
11 Sep 04 |  Health


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