Trials and tribulations of vascular surgical benchmarking

Background Benchmarking is a new tool to assess the efficiency of different hospitals. Classification of operations using healthcare resource groups (HRGs) is related to parameters including number of cases, length of stay (LOS) and age profile. Methods A National Comparative Database was used to compare three hospitals. Analysis was confined to the major HRGs involved with vascular/venous surgery. Results For high-volume low-complexity varicose vein surgery, ail three hospitals had similar numbers of patients and LOS. In contrast, the LOS for routine vascular operations in hospital A was double that in hospital B (16.3 versus 7.4 days). Hospital A had three times as many patients classified as 'other-peripheral vascular disease' as hospital C and six times as many as hospital B (329, 49 and 111 for hospitals A, B and C respectively). LOS following major amputation in hospitals A and C was nearly double that in hospital B (32.4, 18.3 and 33.6 days for hospitals A, B and C respectively). Conclusion There were a number of significant variations between the three hospitals during the 9-month interval. Explanations included the methods of coding, local facilities including availability of rehabilitation beds and difference in the patients' age profiles. Benchmarking in its present format reveals a number of variations which may not necessarily reflect real differences in clinical performance.