FREQUENTLY ASKED QUESTIONS
What is the aim of the BAETS Endocrine Surgery Registry?
The aim of the registry is to provide information on outcomes of endocrine surgery (principally surgery on the thyroid, parathyroid and adrenal glands) in the UK, in order to improve standards of care, through a process of continuous audit.
Who is responsible for running the Registry?
The registry is a collaborative project operated by the British Association of Endocrine and Thyroid Surgeons (BAETS) with Dendrite Clinical Systems Ltd.
The BAETS is a specialist association of British surgeons who have an interest in endocrine surgery, and is recognized as such by the Department of Health, the Association of Surgeons of Great Britain and Ireland, and the British Association of Surgical Oncology.
Dendrite Clinical Systems Ltd. is a specialist supplier of clinical databases, operating multiple national and international clinical databases.
Data Submission and Ownership
Patient data are anonymised at the point of data submission. Dendrite Clinical Systems Ltd. hold the key to surgeon and hospital codes, but do not hold data enabling identification of any individual patient. Data are held centrally by Dendrite Clinical Systems in accordance with UK Data Protection laws. Data cannot be released without the written permission of the BAETS.
Data Confidentiality
Patient data are anonymised at the point of data submission. Dendrite Clinical Systems Ltd. hold the key to surgeon and hospital codes, but do not hold data enabling identification of any individual patient. Data are held centrally by Dendrite Clinical Systems in accordance with UK Data Protection laws. Data cannot be released without the written permission of the BAETS.
How are the data used?
Analyses of the data are published approximately every few years, providing an anonymous summary of surgeons' case-loads, types of conditions treated, ranges of operations performed, and the resulting clinical outcomes (complication rates). Copies of the latest report are available on the BAETS website at www.baets.org.uk
Since 2013, the data have been used to publish individual BAETS members' outcomes for thyroid surgery, in comparison with the national averages. The data presented on this website represent an update of this process.
Individual surgeons are also able to view/download their own results, enabling feedback on their own performance, and thereby contributing to continuous improvements in outcomes. The BAETS also has an 'outlier' policy, whereby surgeons whose nationally published outcomes appear significantly worse than expected can be notified and supported to identify potential areas for improvement.
What results are available on this website?
The website shows, for each named surgeon:
The number of thyroid operations performed in the four years up to 30th June 2014, and for these cases:
- The length of hospital stay following surgery.
- The rate of re-admission for reasons related to the surgery.
- The rate of re-operation for bleeding in the early post-operative period.
- The rate of low calcium levels in the blood after total thyroidectomy.
- In-hospital mortality.
- The extent of completeness of data entry.
- Information on post-operative assessment of vocal cord function.
Why are the published outcomes restricted to thyroid surgery?
Thyroidectomy represents the commonest type of endocrine surgery, and was therefore felt to be most appropriate for the first rounds of outcomes publication.
It is planned, however, to expand the range of outcomes published in future, including those of other endocrine operations, such as parathyroid and adrenal surgery.
What is the relevance of mortality rates in thyroid surgery?
Death after thyroid surgery is, reassuringly, extremely rare. In most cases, such deaths are not directly related to the surgical procedure, and may be due to heart attacks or strokes, for instance. Rarely, some thyroid operations may be performed to alleviate symptoms in patients with advanced cancer, where subsequent death results from the underlying disease, rather than the surgery itself.
By chance, surgeons will therefore inevitably have either one or no patients dying after thyroid surgery, and there are no statistically sound methods to compare such low complication rates.
All confirmed reported deaths are also scrutinized to ensure that none are related to the quality of surgery.
Mortality rates are reported for completeness, but, for thyroid surgery, are not considered related to the quality of surgical care.
Why is my local hospital/named surgeon not listed?
The published results derive solely from the BAETS audit database, which is only accessed by BAETS members. Data submission has traditionally been voluntary, although recently has become a mandatory aspect of BAETS membership.
Not all surgeons who perform thyroid surgery are members of the BAETS.
Surgeons may therefore not be listed if they are not BAETS members or they are members who have not submitted data for the period of analysis.
Hospitals may not be listed if they do not have a BAETS member who contributed data for the period of analysis.
Why can I not view all surgeons' outcomes together e.g. in a table?
Expressing results in the form of 'league tables' is very prone to misinterpretation, particularly for many of the outcomes presented here, where:
- Some complications are relatively rare, so that estimates of the true complication rate are very unreliable for surgeons with a smaller case-load.
- No established statistical models exist for risk-adjustment, so that surgeons taking on more complex cases might have apparently worse outcomes. The results presented here are 'risk-stratified' by excluding a small number of cases with the highest risk of given complications (re-operations and central neck lymph node dissections), but differences will still exist in the complexity of surgery between the remaining cases.
- Multiple different outcomes are presented. Some surgeons may have rates 'higher than average' for some complications and 'lower than average' for others. Therefore, it is difficult to give an overall rating of the quality of surgery.
- The completeness of data varies between surgeons, and might significantly affect the reported complication rates.
The BAETS feel that results are better expressed by alternative means, including funnel plots, which allow for improved understanding of an individual surgeon's results within the spread of data.
Who might find the published information useful?
Patients may find reassurance that their surgeon is participating in a process of professional audit, and may wish to ascertain how often their surgeon performs thyroid surgery, what types of surgery are performed, and how that surgeon's complication rates compare with those of other thyroid specialists. This information may be useful in discussions with a patient's General Practitioner regarding referral to a thyroid specialist, but cannot replace GP's local knowledge, and is not recommended as the sole means for selecting a thyroid surgeon.
GP's and Health Service Commissioners might find the data helpful in supplementing knowledge of local services in thyroid surgery.
Hospital Medical Directors and Executive Boards may refer to the data, to confirm that their local specialists are contributing to national audit and that their performance is acceptable, or to put in place remedial action if that is not the case.
Surgeons will gain improved insight into their own performance, helping to maintain or improve standards.
Healthcare Researchers may derive useful academic information.