League tables 'lower heart surgery death rates'

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Performance 'league tables' have been linked with a fall in death rates following major heart surgery.

British researchers studied 25,730 patients who had coronary artery bypass surgery (CABG) for the first time between1997 to 2005 in the north-west of England.

Thirty different surgeons in four major NHS sites performed CABG during this eight-year period.

Opponents of the public disclosure scheme, where results are made public, argued that it could put surgeons off performing complicated and risky cases.

But the latest report found that not only did the death rate following CABG fall significantly (2.4 per cent to 1.8 per cent) but more complicated cases were also taken on.

This was suggested by the predicted death rate rising steadily from three to 3.5 per cent.

More elderly patients and more of those with kidney disease, a recent heart attack or peripheral vascular disease were treated after the league tables were introduced in 2001.

"If publication of surgical mortality data had driven surgeons to turn down significant numbers of high risk patients we would expect to see that reflected in a decrease in the number of high risk cases coming to surgery. This study suggests that the effect may not be as large as is feared," the researchers argue in the journal Heart.

"If public disclosure can drive data collection and analysis, but does not create significant risk-averse behaviour, its introduction may be beneficial in other areas of medicine."

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