On December 8th 2005 the Scottish Information Commissioner ruled that Information Services (ISD) – a division of NHS National Services Scotland (NSS) – should provide information on the mortality rates of surgeons in Scotland from 2002/3 to 2004/5. This was in response to requests by the Sunday Times and Scotsman newspapers submitted to NSS in February 2005.

In order to comply with this ruling we are now publishing the data we have available.  We would, however, ask that all users consider carefully the following background information before making any attempt to draw conclusions from the figures.

These data are routinely provided to health professionals in Scotland, in confidence, to help them assess the outcomes of treatment of their patients.  Used in this way, and with knowledge of the cases and the local care system they can be an important tool for improving the safety and quality of surgical care.

Taken out of context and without this background information these figures do not provide reliable information about surgeons’ performance.

The main reasons for this are:  

• Surgeons are likely to have higher mortality rates if they take on patients who are iller, older, present as emergencies, or who require more complex or higher risk treatment
• Surgeons who pioneer new treatments may have higher mortality rates than those who take on more routine work
• Surgeons who deal with only small numbers of cases may have mortality rates that differ greatly from year to year owing to random statistical variation.

• Surgical performance is only one factor that influences outcome.  Modern health care is a complex process involving nurses, physicians, allied professionals and others and depends additionally on access to good facilities and equipment. 
  
  
• Some of the cases attributed to surgeons in these tables may have only been under their care briefly as one of a series of episodes of treatment and may not even have been operated on by them since not all cases admitted to surgical units will undergo operation e.g. some may be too ill for surgery.
  
  
• No data of this kind can be guaranteed to be free from inaccuracies - e.g. cases carried out by one surgeon may be attributed to another due to administrative error.  However ISD regularly asks clinicians in Scotland to review these data and to inform us of any errors.
   
• ISD has been pioneering the publication of useful data on health care outcomes for many years – for information on this see Scottish Health Statistics
  
  
• Some hospitals in the UK are now beginning to publish mortality data for patients e.g. for cardiac surgery.  In these cases the data provided have generally been collected specifically for audit purposes and have been partially adjusted for severity (case mix) and approved by the surgeons concerned.  This kind of information should not be compared with the unadjusted data published here.
  
  
• The great majority of deaths under surgical care in Scotland are peer reviewed in the Scottish Audit of Surgical Mortality
  
  
• There is some evidence that publication of data like these can act against the public interest.  Surgeons may be reluctant to operate on high-risk cases if this kind of information is to be made public and judgments of performance made or implied.  This has already happened in some states of the USA where surgical outcome data is routinely published.  (see The Journal of American Medical Association )
  
  
• Surgeons are expected to discuss risks, including mortality, with their patients prior to surgery. A patient who has concerns should ask their surgeon whether he or she participates in clinical audit and, if so, whether he or she could discuss comparative outcomes including mortality rate.