Should surgical outcomes be published?

Abstract

Despite publishing surgical outcomes being a positive step forwards in the progression of England's healthcare system, it has no doubt been faced with criticism and reservations. This review article aims to discuss the pros and cons of publishing individual surgical outcomes, as well as the challenges faced. Publishing outcomes requires data from a number of sources such as national clinical audits, hospital episode statistics, patient-reported outcomes, registers and information from revalidation. As yet, eight surgical specialties have begun publishing their data, including cardiac (coronary artery bypass graft, valve and aortic surgery), endocrine (thyroidectomy, lobectomy, isthmusectomy), orthopaedic (hip and knee replacement), urological (full and partial nephrectomies, nephroureterectomy), colorectal (bowel tumour removal), upper gastrointestinal (stomach cancer and oesophageal cancer removal, bariatric surgery), ear, nose and throat surgery (larynx, oral cavity, oropharynx, hypopharynx and salivary gland cancer removal), as well as vascular surgery (abdominal aortic aneurysm, carotid endarterectomy). However, not all procedures have been addressed. Despite the controversy surrounding the topic of publishing surgical outcomes, the advantages of reporting outcomes outweigh the disadvantages, and these challenges can be overcome, to create a more reliable, trustworthy and transparent NHS. Perhaps one of the main challenges has been the difficulty in collecting large amounts of clinically significant data able to quantify the performance of surgeons.

Character failings in the surgeon fallen from grace: a thematic analysis of disciplinary hearings against surgeons 2016–2020

“…This can be measured objectively during training by effectively grading actions in work-based assessments (WBAs) such as procedure-based assessments (PBAs) and direct observation of procedural skills in surgery (DOPs) 1 . This continues beyond training into independent practice where surgeons may be required to publish outcomes data and generate objective feedback on specific areas of care in the shape of patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) among other formats 2,3 . In effect, we ask surgeons to follow "rules" laid down by regulatory bodies such as the General Medical Council (GMC) 4 , and measure their performance in an act-centered ethical approach which is both deontological (how well surgeons "obey the rules" when acting) and consequentialist (whether they achieve desired outcomes as a result of their actions).…”

What are the essential features of a successful surgical registry? a systematic review

“… 63 66 It is recommended that team level data are published to reflect that outcomes are dependent on the entire surgical team, not solely the consultant surgeon. 66 Minimising the time between the surgical event and the release of data is also important for the identification of faulty implants or unsafe practices. 63 …”

Low compliance with guidelines for re-staging in high-grade T1 bladder cancer and the potential impact on patient outcomes in the province of Alberta

“…Ongoing measurement and reporting of surgical outcomes has been shown to positively influence surgical practice and may be one way of ensuring guideline adherence. 23,24 Published trials have yet to demonstrate that ERR results in improved OS. [11][12][13] The five-year OS rates in our cohort were 72.7%, 60.0%, and 53.8%, respectively, for those who received an ERR, a DRR, and a LRR/no repeat resection.…”