Surgeons will not operate on some patients if league tables are published

Doctors are warning that government plans to publish death rates for individual surgeons could result in high-risk patients being turned away.

Colin Hilton, president of the Society of Cardiothoracic Surgeons, said yesterday: "Young surgeons, especially, will be desperate not to appear at the bottom of any list because it could ruin their lives."

A survey in Pennsylvania, where league tables of individual surgeons' performance were made mandatory, found two thirds said they would be less willing to operate on high-risk patients.

The society says Britain's record in heart surgery equals that of any country in the world.

The first league table of heart surgery death rates to name individual hospitals showed the death rate after coronary bypass surgery, the commonest heart operation, averaged 2.1 per cent in 2001. Germany, Belgium and the Netherlands had the same rate, while in the United States it was 2.6 per cent, the society said.

In a 250-page report, the society gave details of the 40 hospitals doing heart surgery, saying it was an exercise in openness and accountability unprecedented for any specialty in Britain.

The tables showed that one heart unit – at the Middlesex Hospital, which is part of University College Hospitals NHS Trust in London – had a mortality rate above 4 per cent for coronary bypass operations. But further analysis showed that the hospital was operating on the group of patients at highest risk because they were older and sicker than the average. Peter Hutton, chairman of the Academy of Royal Medical Colleges, said: "There is almost a case for congratulation, rather than vilification."

The lowest death rate of 0.9 per cent was at the Bristol Royal Infirmary, scene of the baby heart deaths disaster in the late 1980s and early 1990s. The debacle triggered demands for better monitoring of surgical performance and led to the Kennedy inquiry published last year. None of the figures is adjusted for the age of the patients or severity of their condition.

The Government plans to publish death rates for individual surgeons from 2004. But despite fears about older and sicker patients being turned away, the report showed that closer monitoring of surgeons' performance over the past 10 years had not had that effect. Between 1994 and 2001 the proportion of patients over 75 having heart surgery tripled, while the proportion over 70 doubled. Operations of a more complex nature were being done, and death rates for patients with diabetes and high blood pressure had fallen. "Operative mortality is staying the same but the patients are sicker and we are treating them better," said Bruce Keogh, a cardiac surgeon in Birmingham and joint author of the report.

Roger Boyle, the Government's heart czar, said patients needed information about individual surgeons' death rates to help them to make choices. But that did not mean all patients would choose the same surgeon.

"My father had two heart operations and he was first a high-risk and then a very high-risk patient," he said. "I knew the outcomes for all the heart surgeons in the area, but I did not choose the one with the lowest mortality. I went to the surgeon who had most experience in dealing with his problem."