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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 October 27; 335(7625): 839–840.
PMCID: PMC2043441
Surgical Mortality

Summary of other responses

Sharon Davies, letters editor

Westaby et al make a good case for not publishing unreliable outcome data based on hospital episode statistics (HES),1 but they miss what ought to be two important issues, says Stephen Black, a management consultant in London.

The first concerns how statistical information is presented. “Standard practice gives information to the public and to experts in a form almost guaranteed to mislead. This leads to the erroneous conclusion that members of the public can't be trusted to interpret complex statistics: but they can when they are framed and presented in the right way.”

The second concerns why the information is poor quality in the first place.

Ashok Handa, consultant vascular surgeon in Oxford, agrees: “All surgical units should prospectively collect activity and outcome data. Clinicians should insist on and hospital managers should provide adequate administrative support for this to be a matter of routine.

“The cardiac surgical community to their credit responded to Bristol with routine collection of clinically acquired data for national reporting. Vascular surgeons now also have a national vascular database organised by the Vascular Society. Unfortunately this is largely unfunded and unsupported by NHS managers.”

Westaby et al's criticism of HES and those who use it to profile surgeon performance should not undermine confidence in what is the only mandatory database of NHS hospital activity in England, argues Muhammad Dawwas, specialist registrar in Cambridge. And the statistical evidence leading to the identification of Bristol's outlier status in the 1990s was largely based on HES-derived analyses.

Westaby et al did show that “coding is better in the registry data set than the routine data set and that with better coding you get better data capture,” points out Stephen Duckett, a professor in Queensland. “This suggests adjusting the procedure code definitions in the routine data set rather than abandoning use of the data set altogether.”

And why are registries separate from the routine data sets? Linking the multiple data holdings would enhance use of both data sources. “The registries would then be conceptualised not as special separate clinician data sets but rather as separate modules of the routine data set, giving more power and use to the routine data, leveraging the substantial investment that has been made in this data collection.”


Competing interests: None declared.


1. Westaby S, Archer N, Manning N, Adwani S, Grebenik C, Ormerod O, et al. Comparison of hospital episode statistics and the central cardiac audit database in the public reporting of congenital heart surgery mortality. BMJ 2007;335:759 (13 October.) [PMC free article] [PubMed]

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