In December 2012, the Government outlined plans to publish surgeon-level outcomes data, taken from national clinical audits, in ten specialty areas which included urology (Everyone Counts: Offer 2). This is now known as the Consultant Outcomes Publication (COP) programme.
Although BAUS runs a number of audits itself, there are no nationally-funded urology audits but the Association does strongly support the publication of surgical outcomes. We believe that the release of accurate data on outcomes will drive forward the standards of surgery, help patients make informed decisions about their care, and support surgeons' needs for professional revalidation.
Initially, BAUS took the decision to publish results for nephrectomy (removal of the kidney) because, although not all urologists undertake it, nephrectomy was routinely performed by 35% of the 800 Consultant Urological Surgeons practising in England in 2012. The data capture rate for 2012 was 74%, but this rose to 91% in 2013 and, in September 2015, we included a third year (2014) in the audit. We have now added three further audits (PCNL, SUI & radical prostatectomy, and two more (urethroplasty & radical cystectomy) are in preparation (see below).
We have now published data from 431 individual surgeons, of whom 55 contribute to more than one audit. We are, therefore, displaying data for almost half the 885 Consultant Urologists in the United Kingdom.
The Consultant Outcomes Publication (COP) programme is mandated in England. Although we do collect data from surgeons practising in Wales, Scotland, Northern Ireland and the Irish Republic, submission of their data is voluntary, so we can only publish their data if they give their express consent.
All data were entered voluntarily and have not, therefore, been independently verified by BAUS. We use Hospital Episode Statistics (HES) data to identify units that have not returned any data, but we are unable to use HES to check whether our data is accurate. As a result, we recognise that there may be errors, although individual surgeons have been given several opportunities to check and validate their own data. Some surgeons' returns may be incomplete because they have been unable to submit their data due to time constraints, or because they have lacked support from their Trusts for data collection and/or submission.
Surgical outcomes assessment is not, of course, a new concept to most surgeons. It was formally recognised over 100 years ago (see below) and, whilst there has been no compunction for clinicians to publish outcomes data, a significant number of surgeons have been involved in clinical audit and outcome assessment for many years.
“Soon, there will be a time where our scholars & colleagues will not be satisfied with general comments on surgical quality outcomes – instead, they will call any physician a charlatan who is incapable to quantify his results"
Christian Albert Theodore Billroth, 1860
The "founding father" of modern abdominal surgery