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Urological Surgeons publish individual surgeons' outcomes

Consultant Outcomes Project (COP)

BAUS Nephrectomy Audit for 2012

The British Association of Urological Surgeons (BAUS) has now published individual outcomes data from the Association’s national nephrectomy (removal of the kidney) audit. This audit was chosen because, although there is no single operation all urologists undertake, nephrectomies are routinely performed by about 40% of the 700 Consultant Urologists currently practicing in England.

The nephrectomy database was set up by BAUS in 2001 to monitor and assist the safe introduction of laparoscopic (keyhole) nephrectomy. This database has been amended in recent years to include open nephrectomy, partial removal of the kidney for small tumours and nephro-ureterectomy (removal of the kidney and the tube between kidney and bladder for tumours involving the lining of the upper part of the urinary tract).

This operation may be performed for cancer or benign disease and there are a range of operative techniques used e.g. open or keyhole (laparoscopic) surgery. All surgery has certain risks and complications. Specific complications of nephrectomy include bleeding (haemorrhage) requiring blood transfusion and infection. In this audit, each unit and surgeon’s casemix is shown, together with their risk-adjusted rates in relation to complications, transfusions and mortality, plus figures on length of hospital stay.

The deadline for the production of this 2012 data was extremely tight but data has been returned on 5,360 cases by 284 consultants at 119 centres. We estimate that this is about 80% of the nephrectomies undertaken by urologists in England in 2012. Although the nephrectomy audit has been running for a number of years return rates, have in the past, been about 30% and, like the cardiac surgeons before us, we have found that publication of outcomes does improve participation in national audits.

No risk adjustment had previously been applied to the BAUS data. In conjunction with Dendrite Clinical Systems, we have applied a risk adjustment model but we accept that it is a first attempt which will need further work. In order to improve the model, we intend to add a number of additional questions to the dataset, so that we have more information about the patient’s general health prior to surgery to help improve this process for future years.

There were no outliers; all surgeons are practicing within safe limits and, although some surgeons may appear to have higher than average transfusion or complication rates, this is usually because they treat high-risk patients and, therefore, undertake more complex operations.

The data will be subject to further analysis so that we can learn more from it and disseminate that information to urologists at national and international meetings and through peer-reviewed journals.

Mr Adrian Joyce, Association President, stated: “BAUS sees the publication of consultant level outcomes data as an opportunity to drive up quality of care. Urologists have demonstrated their commitment to this process by engaging in this exercise, no urologists have refused consent for publication of their data.

Our audits are not publicly funded and our staff and members have made an immense effort to deliver this information in a timely manner. We think this is an important first step and we hope the Association will be supported in further developing this work.

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