Surgeon-specific outcomes
The practice of scoring surgeons with infrequently occurring outcomes can at times not be sensitive or specific enough surrogate markers to give an indication of the quality of care(8,9), especially when subjected to confounders. The main confounder of note is the variability in case mix, which may skew the data and throw clinical performers into outlying territory. In cardiac surgery this has become a particular issue with the publication of surgeon-specific mortality data (10).
In the UK, surgeon-specific performance remains central, demonstrated by the use of a traffic light system by the Society for Cardiothoracic Surgeons (SCTS), whereby underperforming surgeons with poor outcomes are assigned an amber light (under monitoring) or a red light (suspension from clinical practice pending investigation) (11). This is an example of outlier detection and castigation in its purest form.
Since its dawn, publication of cardiac surgical data has in fact shown little evidence of improvement in outcomes (12). Studies highlight an increase in risk-averse and loss-averse behaviour by surgeons wanting to avoid operating on high-risk patients (the patients who arguably need the most attention) to circumvent poorer outcomes (13).