ArticleBMJ open2022
Mortality as an indicator of quality of neurosurgical care in England: a retrospective cohort study.
Article in BMJ open, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 1 of them a synthesis that pooled it.
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Who cites it
9 citing papers in PubMed, 1 synthesis or guideline pooled it, 12 citations in OpenAlex.
- Quality indicators in cranial neurosurgery: current insights and critical evaluation - a systematic review.Neurosurgical review · 2024Pooled it
- Use of UK national health databases for detecting intra-cranial aneurysm rupture in the Risk of Aneurysm Rupture (ROAR) study.PLOS digital health · 2026Article
- Socioeconomic disparities in glioma outcomes: a grade-specific analysis.Journal of neuro-oncology · 2026Article
- Patterns of care and outcomes following external ventricular drain placement: Insights from the England HES administrative data set.Brain & spine · 2026Article
- Inpatient neurosurgical mortality in germany: a comprehensive analysis of 2023 in-hospital data.Neurosurgical review · 2025Article
- Evaluation of the quality of postoperative care in neurosurgery at a national referral hospital.Frontiers in surgery · 2025Article
- Perioperative quality indicators among neurosurgery patients: A retrospective cohort study of 1142 cases at a tertiary center.PloS one · 2024Article
- Benchmarking short-term postoperative mortality across neurosurgery units: is hospital administrative data good enough for risk-adjustment?Acta neurochirurgica · 2023Article
- Quality indicators and early adverse in surgery for atypical meningiomas: A 16-year single centre study and systematic review of the literature.Brain & spine · 2023Article
Corrections and comments
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Authors and funding
5 authors at 3 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesPostoperative mortality is a widely used quality indicator, but it may be unreliable when procedure numbers and/or mortality rates are low, due to insufficient statistical power. The objective was to investigate the statistical validity of postoperative 30-day mortality as a quality metric for neurosurgical practice across healthcare providers.
designRetrospective cohort study.
settingHospital Episode Statistics data from all neurosurgical units in England.
participantsPatients who underwent neurosurgical procedures between April 2013 and March 2018. Procedures were grouped using the National Neurosurgical Audit Programme classification. OUTCOMES MEASURED: National 30-day postoperative mortality rates were calculated for elective and non-elective neurosurgical procedural groups. The study estimated the proportion of neurosurgeons and NHS trusts in England that performed sufficient procedures in 3-year and 5-year periods to detect unusual performance (defined as double the national rate of mortality). The actual difference in mortality rates that could be reliably detected based on procedure volumes of neurosurgeons and units over a 5-year period was modelled.
resultsThe 30-day mortality rates for all elective and non-elective procedures were 0.4% and 6.1%, respectively. Only one neurosurgeon in England achieved the minimum sample size (n=2402) of elective cases in 5 years needed to detect if their mortality rate was double the national average. All neurosurgical units achieved the minimum sample sizes for both elective (n=2402) and non-elective (n=149) procedures. In several neurosurgical subspecialties, approximately 80% of units (or more) achieved the minimum sample sizes needed to detect if their mortality rate was double the national rate, including elective neuro-oncology (baseline mortality rate=2.3%), non-elective neuro-oncology (rate=5.7%), neurovascular (rate=6.7%) and trauma (rate=11%).
conclusionPostoperative mortality lacks statistical power as a measure of individual neurosurgeon performance. Neurosurgical units in England performed sufficient procedure numbers overall and in several subspecialty areas to support the use of mortality as a quality indicator.
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