Background

In the UK, cardiothoracic surgeons have led the outcome reporting revolution seen over the last twenty years. The objective of this survey was to assess cardiothoracic surgeons opinions on the topic, with the aim of guiding future debate and policymaking for all subspecialties.

Methods and Results

A questionnaire was developed using interviews with experts in the field. In January 2015, the survey was sent out to all consultant cardiothoracic surgeons in the UK (n=361). Logistic regression, bivariate correlation and the chi-square test were used to assess whether there was a relationship between answers and demographic variables. Free text responses were analysed using the grounded theory approach. The response rate was 73% (n=264). The majority of respondents (58.1% oppose, 34.1% favour, 7.8% neither) oppose the public release of surgeon-specific mortality data (SSMD) and associate it with a number of adverse consequences. These include risk-averse behaviour, ‘gaming’ of data and misinterpretation of data by the public. Despite this, the majority overwhelmingly supports publication of team-based measures of outcome. The free text-responses suggest this is because most believe that quality of care is multifactorial and not represented by an individual’s mortality rate.




Conclusions

There is evident opposition to SSMD amongst UK cardiothoracic surgeons who associate this with a number of unintended consequences. Policy makers should refine their strategy behind publication of SSMD and possibly consider shift towards team based results for which there will be the required support. Stakeholder feedback and inclusive strategy should be completed prior to introducing major initiatives to avoid unforeseen consequences and disagreements.

Key words

Quality assessment, outcomes research