Introduction: Having been trialled successfully in cardiac surgery, publishing surgeon specific mortality has been a recent initiative to improve the quality of care in many surgical specialties including neurosurgery. But there is little data available as to whether mortality is indeed a good indicator of the quality of care in neurosurgery. We conducted a study to test this hypothesis.
Methods: Hospital mortality records from 2008 January to 2016 January were analysed. Data on outpatient appointments and admissions and operations were also collected. In depth analysis of mortalities from January 2012 to January 2016 was undertaken. Causes of death were divided into unavoidable, potentially avoidable and avoidable deaths according to preset criteria.
Results: 200 mortalities were found in the time period studied. This was 0.96% of patients who were admitted or less than 0.3% of patients who had neurosurgical care in that time period. The vast majority of neurosurgical deaths were unavoidable, with mortality being determined by the primary pathology, rather than by the quality of care provided. Only seven deaths were deemed to be potentially avoidable(0.03% of admissions) and there were no deaths which were deemed to be avoidable with better neurosurgical care.
On cross checking the mortality rates for one year with another hospital held database source; 60 -90% error rates were detected
Conclusions: Mortality rates in neurosurgery are a poor reflection of the care provided.. By far, most deaths in neurosurgery are unavoidable, with mortality being determined by the primary pathology, rather than by the quality of care provided.. Focussing on mortality alone, ignores what happens to more than 99% of patients admitted under neurosurgery. To compound this, data which has been used to populate national mortality may have very high error rates.
Patient Care: Using the morbidity index alongside the mortality rate can help providing better patient care
Learning Objectives: more avoidable problems leading to morbidities in patients rather than mortalities. Using the morbidity index alongside the mortality rate can help providing better patient care