Consultant-level outcomes data for orthopaedic surgeons launched
Joint statement from the British Orthopaedic Association and National Joint Registry
Information is being published for the first time on 1,594 orthopaedic surgeons conducting hip and knee replacement surgery for the NHS in England. Orthopaedics is the largest of nine surgical specialities launching outcome information as part of an NHS England initiative in a move to improve quality and inform patients.
Martyn Porter, President of the British Orthopaedic Association, commented, “This is an important first step towards greater transparency of surgical outcomes. I am pleased that this demonstrates that standards in orthopaedics are high – with very low levels of mortality and no surgeons classed as outliers in terms of their individual performance. I believe our outcomes and standards in British Orthopaedics are second to none, and I hope patients will be reassured by this.”
The data released today has been collected through the National Joint Registry (NJR), an audit of hip and knee replacement surgery that has been running for over ten years. More than 1.4 million operations have now been recorded and the NJR is currently the largest register of its type in the world.
Laurel Powers-Freeling, Chair of the NJR Steering Committee added, “We are committed to our involvement in these first and future steps towards greater transparency of joint replacement outcomes. We will continue to work with surgeons and their hospitals to enhance data quality and in turn, develop the service for the benefit of future patients.”
The information being published covers elective hip and knee replacement surgery and includes details on the number of procedures undertaken and overseen by each Consultant in Charge, the units where they have worked and the mortality within 90 days of surgery.
Data have been adjusted in an attempt to take into account the varying risk profiles of differing patients (this is called “case-mix adjustment”). The aim is to ensure that surgeons who take on complex, higher risk cases are not unfairly criticised for having higher death rates. It should be emphasised that no surgeons were classed as outliers in terms of individual performance.
There are a small number of surgeons for whom data has not been published. Less than 0.6% of orthopaedic surgeons did not consent to have their surgical outcomes published and their names are included on NHS Choices along with their reasons for taking this action. These surgeons declined this year citing concerns over the completeness and quality of the data mandated for publication. In addition, data for some surgeons requires additional validation before it can be published, and this will be taking place over the coming weeks. Importantly for both groups, their current data has been included in the analysis of surgical outcomes (mortality) and their results were also within the expected range.
Surgeons should not be ranked by their mortality rate as there is a risk that they will be wrongly criticised and patients misled. The mortality rate after hip and knee replacement surgery is influenced by many factors outside the control of the operating surgeon. Case-mix adjustment is a useful tool but as with any methodological approach it cannot account for all differences including those that may be due to random events.
In December 2012, NHS England (then NHS Commissioning Board) announced that through the 'Everyone Counts' initative, the activity and outcomes of surgery at individual consultant-level would be published by 30 June 2013 for ten clinical areas. Orthopaedics is one of the ten clinical areas to publish consultant-level data for total hip replacements and total knee replacements. The National Joint Registry (NJR), as the appointed national clinical audit, has been supporting the corresponding professional body, the British Orthopaedic Association (BOA), in meeting the requirements of the initative. The process of publication across all ten clinical areas is being managed and guided by the Healthcare Quality Improvement Paretnership (HQIP) who have set up dedicated pages at their website: www.hqip.org.uk/everyone-counts.
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