In December 2012, the Government outlined plans to publish surgeon-level outcomes data in ten specialty areas, including urology (Everyone Counts: Offer 2). This is now known as the Consultant Outcomes Publication (COP) programme.
Although BAUS runs several audits itself, there are no nationally-funded urology audits. The Association, however, strongly supports 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.
In 2012, 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 at that time. We now publish data on a further five audits - percutaneous nephrolithotomy (PCNL), surgery for stress urinary incontinence (SUI), urethroplasty, radical prostatectomy and radical cystectomy.
We have now published data from 629 individual surgeons, of whom 258 contribute to more than one audit. We are, as a result, displaying data for almost two thirds of the Consultant Urologists in the United Kingdom.
The Consultant Outcomes Publication (COP) programme is mandated in England and Scotland. Although we do collect data from surgeons practising in Wales, 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.
Verification of data
All data were entered voluntarily and have not, therefore, been independently verified by BAUS. We use Hospital Episode Statistics (HES) to identify units that have not returned any data, but we are unable to use HES to check whether the 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 a new concept to most surgeons. It was recognised over 100 years ago (see below) and, whilst there has been no requirement for clinicians to publish outcomes data, a significant number of urologists 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"