According to a study published yesterday on bmj.com, English NHS hospitals have a large variation in unplanned re-operation rates after colorectal surgery. Researchers recommend using re-operation rates alongside other quality measures to help improve surgical performance on a national scale.

Variation in surgical performance is becoming increasingly intolerable to clinicians, healthcare managers, commissioners, and patients. One of the most widely recognized quality indicators is death; however, in isolation, its use is restricted. A range of indicators is required to improve measure performance and raise standards.

Researchers at the Imperial College in London used Hospital Episode Statistics (a dataset covering the entire English NHS) to define national re-operation rates after colorectal surgery and to evaluate the feasibility of using re-operation as a quality indicator.

The study utilized data from a total of 246,469 patients in 175 English hospital trusts who underwent colorectal surgery for the first time between 1 April 2000 and 31 March 2008. 15,986 of these patients (6.5%) required further surgery (re-operation).

Emergency patients had a marginally higher re-operation rate compared to elective patients. Male patients, and patients suffering from inflammatory bowel disease or other existing conditions were also more prone to need further unplanned surgery.

Researchers discovered significant variation in re-operation rates among hospital trusts and individual surgeons. Trusts performing more than 500 procedures showed a fivefold difference in highest and lowest re-operation rates after elective surgery (14.9% v 2.8%), with trusts performing more than 2,500 procedures during the study period, the variation was threefold (11.5% v 3.7%).

The authors said, “This study supports the feasibility of using re-operation rate as a quality indicator derived from routinely collected data across a range of surgical specialties,” suggesting that re-operation rates, along with existing quality indicators such as mortality, could offer a powerful means of checking quality of surgical care.

Arden Morris, Associate Professor of Surgery at the University of Michigan welcomes the study in an accompanying editorial, but argues, that “measuring quality is only the first step in the more important goal of improving quality.” She continued by saying that a call for mandatory reporting of re-operation rates “is unlikely to result in a change in surgical technique” and he urges researchers “to propose mechanisms by which their data can be used for quality improvement – by individual providers, hospitals, and policy makers.”

Written by Petra Rattue