Study reveals disturbing rate of failure among some surgeons
Thousands of patients are being forced to go under the knife for a second time because as many as half the operations carried out by some NHS surgeons end in failure.The disturbing finding comes from a study of bowel surgery, one of the commonest operations carried out on the NHS.
Patients whose bowel operations fail and have to be redone – usually because of bleeding, infection or leakage from the gut – face a four-fold increased risk of dying from surgery – up from 2.9 per cent to 11.9 per cent – and spend more than twice as long in hospital (27 days compared with 11).
There is growing concern in the NHS over variations in the quality of care between NHS trusts and individual surgical teams and about how to improve the outcomes of the poorest performers.
Researchers from Imperial College, London, investigated re-operation rates following bowel surgery to discover how wide the variation was and what might be done to boost performance. They examined almost 250,000 bowel operations conducted between 2000 and 2008 in England.
Predictably, the results showed that the trusts performing the most operations had the best results. But even among these there were wide variations, with re-operation rates ranging from 3.7 per cent to 11.5 per cent.
Overall almost 16,000 patients required further surgery to correct something that had gone wrong – one in every 15 procedures.
The study is published in the British Medical Journal. The worst-performing trusts and surgical teams are not named in the report, but an earlier study last April identified Burton Hospitals NHS Foundation Trust in Derbyshire as having the highest death rate following surgery for bowel cancer at 15.7 per cent, or one death in every 6.3 operations.
Omar Faiz, consultant colorectal surgeon and lead author of the study, said re-operation rates should be used with death rates to measure the quality of care in the NHS across a range of operations, provided the data was proved to be accurate.
Re-operation rates of 50 per cent were rare and reflected very unusual circumstances, such as when non-specialist surgeons were required to operate in emergencies.
“If there really are differences in performance that can’t be explained then the professional organisations will have to look at that,” he said.
Professor Norman Williams, president of the Royal College of Surgeons said the overall re-operation rate (6.5 per cent) was “quite impressive” and compared well with other countries. “We shouldn’t be complacent. If some surgeons truly have a 50 per cent re-operation rate it is extremely worrying.”
The college had said specialist surgery should be centralised in fewer hospitals and had encouraged surgeons to monitor performance.
Katherine Murphy of the Patients Association said: “We are supposed to have an NHS with patients at the centre, but it is still far from a patient-led service. They might get a choice of hospital but they are never given details of individual consultant performance, except in cardiac surgery. If they can do it in cardiac surgery why can’t we have it right across the NHS?
“These findings also emphasise the need for consultants to have regular tests [“revalidation”] by the General Medical Council to ensure they are up to date – but we are still waiting for it to be introduced,” she added.
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