PUBLICATION OF INDIVIDUAL SURGICAL OUTCOMES
The publication of individual surgical outcomes in Ireland is
increasingly likely. In the UK, Professor Sir Bruce Keogh, Medical
Director of the NHS (and a cardiac surgeon) has introduced the
reporting of individual surgical outcomes across a range of specialties.
However, the UK experience has shown that the effectiveness of
surgical outcome studies in improving patient care and driving
surgical excellence will depend on the quality of data gathered and the
rigour of the methodologies employed. Moreover, the interpretation
of the data must be nuanced and informed by a comprehensive
understanding of what is being measured and the significant
differences that exist between specialties as well as, between
the particular demands and specific challenges of, for example,
hepatobiliary surgery and vascular surgery.
An individual surgeon, who develops skills in a particularly
complex field of surgery, may have higher mortality outcomes than
another surgeon carrying out, what may be, comparatively, more
straightforward procedures. In interpreting their mortality outcomes,
due consideration must be given to the specific nature of the surgical
work each surgeon undertakes. We must also be mindful of the
concerns expressed by some surgeons in the UK that inaccurate
or misinterpreted data could lead to younger surgeons being
discouraged from attempting difficult surgery.
Ultimately, the introduction of reporting on individual surgical
outcomes has the potential to have a positive impact on patient care
and surgical skills, if, and only if, we can have confidence in the
accuracy and reliability of the data.
THE IRISH SURGICAL OUTCOMES STUDY (ISOS)
The dangers of inaccurate data were highlighted in the Irish Surgical
Outcomes Study (ISOS), published in The Lancet in December 2013
as a rebuttal to the European Surgical Outcomes Study (EuSOS), also
published in The Lancet in September 2012.
The EuSOS had reported a 6.4% mortality rate for Ireland. This
finding was seriously concerning to RCSI, as the national body
responsible for education, training and the standards of surgical
practise in Ireland.
When the EuSOS data was not made available by the UK-based
authors to enable a clearer understanding of the potential areas
of concern (as would be expected in the international research
community), RCSI commissioned a replication study (ISOS) to
validate the data and the methods of data collection. The ISOS was
a retrospective study examining patients' charts for the same time
period (April 4 to April 11, 2011) as the original study in the same
17 hospitals with the same data collection tools from the EuSOS, in
order to validate the findings. If the findings were replicated, then
there would clearly be a serious need to reappraise surgical practice
in Ireland if not, then the inaccurate representation of Irish surgical
outcomes needed to be addressed. Using the same methodology, time
period and hospitals as the EuSOS, the ISOS found 25% more eligible
patients, a 39% lower critical care admission rate and 68% lower
mortality rate than that reported by EuSOS. The inaccuracy exposed
by the ISOS underlines the vital importance of methodological rigour
in reporting data.
As President of RCSI, I want to commend the Council for supporting
us in refuting the EuSOS. I also want to thank the steering committee
which oversaw the ISOS in particular Professor Hannah McGee,
Dean of the Faculty of Medicine and Health Sciences, RCSI. The
rebuttal study was a complex project undertaken at considerable cost
and in this regard I want to acknowledge the invaluable support of
Professor Cathal Kelly, CEO, RCSI.
THE PRESIDENT WRITES...
AN UPDATE FROM PROFESSOR PATRICK BROE
PROFESSOR BROE REPORTS ON A RANGE OF PRESSING ISSUES INCLUDING
THE IMPORTANCE OF RIGOROUS METHODOLOGY IN MEASURING SURGICAL
OUTCOMES, ENHANCEMENT OF RCSI'S GOVERNANCE STRUCTURES AND
PROGRESS IN DEVELOPING THE SURGICAL TRAINING PATHWAY