Dear Sir,
With regard to surgeons publishing individual complication rates it is all well and good for a surgeon to publish those but who has checked that all cases have been entered and who has checked that the complications quoted are accurate and have not been sanitised?
Since January 1, 2010 the Australian and New Zealand Society for Vascular Surgery (ANZSVS) instituted a web based, independently reviewed audit of all significant vascular surgical procedures throughout Australia and New Zealand. This, the Australasian Vascular Audit (AVA), is a compulsory audit for all ANZSVS members to record the results of the major life and limb threatening groups of surgery they perform as vascular surgeons. The complications are subject to independent peer review and the accuracy of the data is verified by both internal and external random checking mechanisms. If there are outlying results these are analysed by a peer group and if necessary remedial action for the surgeon is undertaken by the Society. Publically available annual reports are published.
Annual Certificates of Participation are awarded to those vascular surgeons who participate. It is compulsory to have a current Certificate to maintain membership of the ANZSVS. Any patient who visits a vascular surgeon should be able to ask the surgeon if he is a member of the ANZSVS and could ask to see the Certificate as proof. That Certificate in turn is proof to the patient that the vascular surgeon before them subjects his surgery to peer review and will have any deficiencies corrected.
The AVA has gained international recognition. This is surely the correct way to deal with this complex problem. The ANZSVS has outlaid 100s of thousands of dollars to make this work bearing testimony to its commitment to high-quality care in vascular surgery throughout Australia and New Zealand.
Rather than ridiculous league tables which are subject to manipulation and which will encourage risk aversion and therefore poor outcomes for those patients missing out on necessary surgery ( because they are "too risky"), I would encourage the Royal Australasian College of Surgeons to bring real pressure to bear on all surgical specialties to introduce, at their own expense ( as has been done by the ANZSVS) an independently reviewed audit of risk adjusted complications with a mechanism to remedy and, if necessary retrain, any surgeon who has outlying results.
This is fair for both the patient and the surgeon
Dr Bernie Bourke
Immediate Past President of the Australian and New Zealand Society for Vascular Surgery.
