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Ethics in Cardiothoracic Surgery

The Ethics of Transparency: Publication of Cardiothoracic Surgical Outcomes in the Lay Press

^a The Congenital Heart Institute of Florida, Division of Thoracic and Cardiovascular Surgery, All Children's Hospital and Children's Hospital of Tampa, University of South Florida College of Medicine, Cardiac Surgical Associates of Florida, Saint Petersburg and Tampa, Florida
^b Section of Thoracic Surgery at University of Alabama at Birmingham, Division of CardioThoracic Surgery, Department of Surgery, Birmingham, Alabama
^c Division of Cardiothoracic Surgery, Department of Surgery, Institute of Human Values in Health Care, Medical University of South Carolina, Charleston, South Carolina

Accepted for publication December 12, 2008.

^_* Address correspondence to Dr Sade, Department of Surgery, Medical University of South Carolina, 96 Jonathan Lucas St, Ste 409, PO Box 250612, Charleston, SC 29425 (Email: sader@musc.edu).

Presented at the Fifty-fourth Annual Meeting of The Southern Thoracic Surgical Association, Bonita Springs, FL, Nov 7–10, 2007.

Cardiothoracic surgical (CTS) outcomes have been published in the lay press for nearly 2 decades. Pressures to expand such publication come from many different areas and cannot be resisted indefinitely. Evidence exists that contemporary reporting of outcomes data is based on flawed methodologies that potentially mislead and deceive. Such deceptions may harm patients, surgeons, and hospitals in various ways, and could undermine quality of surgical care and patients' access to it. Yet, public reporting of outcomes can also be beneficial to all concerned, but only if relevant data are accurate and the formats in which they are reported are valid and easily understood.

In this essay, we review the early history of public reporting of CTS outcomes, discuss potentially negative aspects of public reporting, and suggest solutions to these problems. We then consider the positive aspects of public reporting and provide recommendations for the future. We conclude that CTS data should be collected and analyzed under the direction of professional medical societies and that reports of outcomes based on such data should be published in the lay press.

	The History of Public Reporting

 
In December 1990, New York state officials publicly released hospital-specific data on raw as well as risk-adjusted mortality for patients who underwent coronary artery bypass grafting (CABG). In January 1992, specific mortality figures for individual surgeons as well as for hospitals were reported. In November 1992, Pennsylvania followed suit [1]. From the outset, the methodology of New York's Cardiac Surgery Reporting System (CSRS) for adjusting risks and for comparing hospitals and surgeons has been intensely criticized. The prognostic accuracy of the CSRS model and whether it could adequately account for case–mix variations among surgeons has been challenged. Anecdotal reports suggest that some surgeons may have tried to avoid reporting adverse statistics by referring some of their sickest patients elsewhere. These . . . [Full Text of this Article]

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