Replies to LegCo questions

LCQ20: Oesophagectomy operations

Following is a question by the Hon Michael Mak Kwok-fung and a written reply by the Secretary for Health, Welfare and Food, Dr Yeoh Eng-kiong, in the Legislative Council today (February 19):

Question:

It has been reported that an investigation has revealed that, out of the 13 public hospitals in which oesophagectomy operations are performed, the post-operative mortality rates of patients of ten of these hospitals were higher than the average international benchmark. Regarding the mortality rates of patients after undergoing excision operations in public and private hospitals, will the Government inform this Council whether:

(a) it will investigate the reasons for the relatively higher mortality rates of patients after undergoing excision operations in some public hospitals, for instance, whether this is attributable to the skills of the surgeons; if no investigation will be conducted, of the reasons for that;

(b) it has monitored the skills of surgeons in public hospitals who performed excision operations to see if they meet international standards, and how it protects the patients' rights to proper surgical treatments; and

(c) it has compared the mortality rates of patients after undergoing such operations in public hospitals to those of private hospital patients; if it has, of the results?

Reply:

(a) A clinical audit conducted by the Hospital Authority (HA) in end 2002 on the surgical outcomes of oesophagectomy of 13 public hospitals during the period January 1997 to June 2002 revealed that the clinical outcomes of all 13 hospitals in question were generally on par with international standard. The average mortality rate for the procedures was 11 per cent. By way of comparison, the mortality rate of such procedures in the US was in the region of 5 per cent to 16 per cent (5 per cent in two states and 16 per cent under the US Medicare Scheme). As in the case of Hong Kong, there were significant inter-hospital variations. In conducting the inter-hospital comparison on the clinical outcomes of the hospitals, it is necessary to adjust the data statistically to reflect the characteristics of patients and exclude the variation in outcomes due to uncontrollable random factors. On the basis of the risk adjusted and age standardized data, it was found that two out of the 13 hospitals had statistically significant higher mortality rates. There was no evidence from the audit results that the high mortality rates for the two hospitals were caused by substandard surgical skills. The high mortality rate of one hospital was due to the high-risk nature of the operations performed on patients. Also, random variation could not be excluded as the number of patients being operated on was small. In fact, the hospital concerned had ceased conducting such operations within the audit period. HA is taking appropriate follow up action with the other hospital to review the causes of the high mortality attributed by system factors, including the suitability of the patients for operation, the pre-operative condition of the patients and the post-operative care provided for the patients.

(b) HA cultivates a continuous quality improvement culture among its health care professionals with emphasis on system and process problems, monitoring feedback and evaluation of the outcomes of clinical interventions. Clinical governance is enhanced through knowledge management, the development of clinical guidelines and protocols, clinical supervision, as well as clinical audits and outcome evaluation. Clinical audits are regularly conducted by way of structured peer review to set standards for different clinical interventions in different specialties with a view to minimising the risks of clinical activities. Through this system of peer review, clinicians will examine their practices and review results of operations against standards agreed among their peers to improve the outcome of patient care.

We have put in place a system to protect the rights of patients to receive quality health care services. HA operates a two-tier complaint management system. Members of the public dissatisfied with the provision of public hospital services can in the first place file a complaint with the hospital concerned or the HA Head Office. If the complainants are not satisfied with the outcome of investigations conducted at the hospital or HA Head Office level, they can lodge an appeal with the HA Public Complaints Committee which is chaired by a non-executive member of the HA Board, with members drawn from the community and the HA Board. Complaints related to the professional misconduct of doctors can also be directed to the Medical Council of Hong Kong, a statutory professional regulatory body responsible for regulating local medical practitioners. In the event a doctor is found guilty of professional misconduct, the Council can as appropriate institute punishment, ranging from warning to removal of the doctor's name from the registers of medical practitioners.

The existing system also provides further safeguards in that deaths caused by any operation or deaths that occurred within 48 hours after any major operation are reportable under the Coroner's Ordinance (Cap. 504). The coroner may investigate or conduct an inquest into these reportable deaths as he deems fit.

(c) According to the clinical audit study conducted by HA, the average mortality rate of oesophagectomy for public hospitals during 1997 to June 2002 was 11 per cent. There is no statutory requirement for private hospitals to report mortality rates of operations to the Government. As such, we do not have mortality rates of oesophagectomy for private hospitals. In any event, for the reasons given in (a), such as difference in disease complexity and severity of patients, and random variation, it is not meaningful to make a simple comparison of the mortality rates of such operations conducted by public and private hospitals.


End/Wednesday, February 19, 2003
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