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).