Surgeon's and their "Stats"

[deck1434]

Just an FYI for those of you who may be ignorant, like I was of this fact. Things, as we know, are not always as they seem. I have it on good authority that there are surgeons out there who refuse to treat patients whom they consider high risk, because a negative outcome would adversely affect their track record, or stats...

Thus, a surgeon's success rate may not be accurate, as it might be based on the treatment of only lower risk patients (the chosen ones), rather than patients as a whole.

I found this information very disturbing, but of course surgeons and doctors (and pretty much anyone else) have the right to decide who they do and do not want to treat, for any reason or no reason.

Best,
Dianne

 

[Lynlw]

Yep it has always been like that, That's why some of the centers that take the worse of the worse, stats might be a little lower. Another thing to consider when looking at stats is, is the hospital a trauma center, since alot of time surgeons in trauma centers operate on really messed up people car accidents, gunshots, that surgeons in Hospitals that aren't trauma centers don't get.

 

[geebee]

You are correct - that happens more than one would like. However, personally, I would be more than happy to be refused treatment by a surgeon working under that criteria. I would not want to be his/her patient.

 

[catwoman]

I'm not so sure all surgeons would refuse a case just to keep his/her track record looking good.

More likely, the situation would be one that involves something the surgeon doesn't have the level of experience/knowledge needed, etc. Such a surgeon would probably know which colleagues would be best suited for those cases. I'd hate to be operated on by someone who was too cocky to realize my case wasn't his/her cup of tea.

But ... yes, surgeons who have devoted their careers to extremely difficult cases may not have the track record of others. On the other hand, they are experienced enough that they do know how and what to do to make those surgeries a success, not just in the OR, but afterwards, too. We've all heard "Well, the surgery was a success, but the patient didn't survive."

 

[ALCapshaw2]

I recall reading a post some time ago which addressed what happened in New York when it became State Policy that Surgeons had to make their 'stats' public.

As I remember it, one well known surgeon was seen as having a 'lower than average' (or maybe lower than some of his peers) because he was the 'go to guy' for Complex / Critical Cases.

Again, as I recall the story, he alledgedly began to turn down 'difficult' patients, refering them out of state. The following year, his 'stats' were in line with those of his peers.

It seems that stats can say anything one desires if they define the scope of the stats 'properly'.

 

[Ross]

Just another reason why I do not believe in stats at all. They are only good if your not on the short end of the stick.

 

[sue943]

This is from the website of the hospital that where my surgeon works, St George's in London.

"Adjusting for risk

Heart operations like any major procedure carry a small risk of death (mortality).

This risk varies according to a number of factors such as the condition of the heart, age, other medical conditions, whether the operation is an emergency etc. So every patient has an individual risk, which is unique to them.

In general, surgeons or units with a low mortality might be assumed to be safer than those with a high mortality. Unfortunately, this is not always the case.

A surgeon with an apparently high mortality may actually be taking on a lot of very sick high risk patients, while the surgeon with a low mortality operates on mainly low risk stable patients. Paradoxically the surgeon with a high mortality may actually be performing better than the low mortality surgeon!

It is very important that the risk of the patients operated on is considered, because otherwise surgeons and units may refuse to operate on high risk patients for fear of being labeled as unsafe when their results are published. We know that these high risk patients often have the most to gain from surgery and this would therefore be very counterproductive.

What is needed is a way of comparing like with like.

It is not practical to make the range of cases operated on by different surgeons or units identical, so instead we use Risk Adjustment to account for the fact that surgeons' caseloads are not identical.

This is how it is done:

* We calculate the risk of mortality for every individual patient taking into account all of the factors known to affect this (see below).
* We can then calculate a total predicted mortality for all of the patients operated on for a surgeon.
* By comparing this predicted mortality with the actual mortality we can judge whether the surgeon is performing better or worse than predicted and by how much.
* We can also compare different surgeons or units even if they have very different caseloads.

The Risk Adjustment method we use is called Euroscore. This has been has been extensively tested across Europe, Australia and the USA and been found to work very well."

They post the mortality rates for each surgeon, mine fell in the middle of the range and should I need further surgery I would be happy to have him operate again.

 

[epstns]

Ross, I still remember what my high school algebra teacher used to say. . .
"Figures never lie. Liars often figure." Not that I'm implying that these surgeons lie, just that they may alter their behavior to make their statistics become what they want to show. . .

 

[Ross]

It's funny in a sense. I was given a 5% chance of making it out of my rupture alive. I made it. I was given 50/50 for aortic valve replacement and honestly, I think just about everyones true chances, if you want to play stats, is 50/50.

 

[skeptic49]

Sue, thanks for posting that interesting article. I'll have to look for the "Euroscore" rating method and see if that is in use in the US as the article indicates.

Jim

 

[AgilityDog]

Ya know what they say: "lies, damned lies, and statistics."

 

[deck1434]

Gina,
I agree with you, and love your quotes! - Dianne

 

[deck1434]

Sue,

Very interesting information!! - Dianne

 

[Lynlw]

This might interest some of you , (but once again might be long and boring )The Leading CHD surgeons actually worked a few years on a Aristotle Complexity Score where they rank the difficulty/complexity of every CHD surgery. Since valves, ect fall under CHD replacement/repairs are ranked according to difficulty (range is 1-15)Here is why they did it
"DEVELOPMENT
The motivation behind the Complexity Score Project was a growing frustration of pediatric cardiac surgeons over the fact that their surgical performance was being evaluated based on hospital mortality without regard for the complexity of the operations performed. A working group of Congenital Heart Surgeons from Europe and the United States decided to develop a risk-stratification method which could be adapted to our specialty.

When starting this project in 1999, two difficulties were encountered: 1) Multi-institutional databases were just starting and there was no reliable data yet available. 2) Due to the absence of risk stratification, the more prominent centers dealing with the sickest patients and potentially having a significant mortality were very reluctant to send their data. It was, therefore, necessary to base this risk-adjustment on an evaluation that was largely subjective. Following many discussions, it was concluded that a subjective probability approach based on the consensus of a panel of experts was valid, provided that the risk-adjustment score is subsequently validated based on collected outcome data.

A group of 50 internationally accepted experts has been working for more than five years on a new method to evaluate the quality of care in Congenital Heart Surgery (CHS) that is called Aristotle. Senior, experienced congenital heart surgeons considered the possible risk factors for each procedure and assigned scores based on potential for mortality, potential for morbidity, and anticipated surgical difficulty.
The Aristotle system, electronically available, has been introduced by both the European Association for Cardio-Thoracic Surgery (EACTS) and Society of Thoracic Surgeons (STS) as an original method to compare the performance of Congenital Heart Surgery (CHS) centers. Pediatric cardiologists have joined the project and are currently developing a complexity score for interventional cardiology procedures."
COMPLEXITY CONCEPT
The Aristotle system is based on an original concept of complexity which is a constant for a given patient all over the world. Many variables can affect patient care performance, and most are difficult to define and are not constant among care providers or institutions. Complexity of a given patient with a specific medical condition undergoing a surgical procedure at a given time, however, is a constant regardless of the location around the globe. Defining complexity based on surgical procedures and the factors that may significantly modify the clinical outcomes of those procedures can provide the quantitative basis for evaluation of performance.

The complexity issue has generated more than 20 scientific presentations at various scientific societies including: American Association for Thoracic Surgery (AATS), STS, EACTS, Congenital Heart Surgeons Society (CHSS), European Congenital Heart Surgeons Association (ECHSA) and Association of European Pediatric Cardiology (AEPC).
WHY ARISTOTLE?
The project was named Aristotle, to support an approach based upon expert opinion, with reference to Aristotle’s writing (Rhetoric, Book I, 350 BC); “When there is no scientific answer available, the opinion (Doxa) perceived and admitted by the majority has value of truth.”

COMPONENTS
The Aristotle adjustment method objectively rates the projected complexity of the surgical procedures performed. The complexity score is based on three subjective determinations; potential for mortality, potential for morbidity, and anticipated surgical difficulty. Complexity is calculated in two phases. First, the basic complexity of the procedure involved is scored. Scores range from 0.5 to 15.0. The Basic Aristotle Complexity Score rates only the simplest form of the procedure and does not take into consideration factors which can significantly alter the projected complexity and outcome of the operation. Second, specific value is added, based on a precise analysis of the associated pathology along with any co-morbid conditions potentially present.

The Comprehensive Aristotle Complexity Score considers other significant complicating factors which will impact on the eventual outcome. Procedure dependent factors include anatomical variations, associated procedures, and patient age, and can add a maximum of 5 points to the basic score. Procedure independent factors include patient characteristics which are more general, but have the potential to significantly affect the outcome. Procedure independent factors can add up to an additional 5 points. The mechanism used to assign scores defining the level of added complexity was same process that resulted in the Basic Aristotle Complexity Score.

IF you click on "basic Score", there is a box to check that you agree ... after that it will take you to the long list of the surgeries and their Basic score

http://www.aristotleinstitute.org/aboutScore.asp