(Cardiac surgery: the fall guy in medical quality assurance)
The irony of recent investigations into performances of cardiothoracic surgeons is that in the UK cardiothoracic surgery has better data and is more subject to internal scrutiny than any other specialty, says Bruce Keogh of the Society of Cardiothoracic Surgeons of Great Britain and Ireland in this week's BMJ.
The author details the development of an internal audit system within the Society over the past twenty years and how the information collected has become more accurate and more meaningful over this period. He notes that evidence based medicine indicates that those patients most likely to benefit from cardiac surgery are usually the sickest, with the most damaged hearts and therefore those with the greatest surgical risk. Thus the auditing of performance based purely on mortality is imperfect and would ensure that patients who might otherwise benefit would be denied an operation.
Keogh concludes that the specialty of cardiothoracic surgery is the "tip of the iceberg in medical quality assurance" and that the challenge is for other medical and surgical specialties to produce realistic, measurable and auditable outcomes.
Contact:
Dr Bruce Keogh, Chairman, Database and Information Committee, Society of Cardiothoracic Surgeons of Great Britain and Ireland, c/o Concorde Services, 10 Wendell Road, London W12 9RT B.E.KEOGH@bham.ac.uk