, Volume 23, Issue 1 Supplement, pp 4-5
Date: 20 Feb 2014

Funnel plots and spine surgery: unit level and surgeon level outcome data

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A funnel plot is a scatter plot of treatment effect against a measure of study size. Introduced by Light and Pillemer in 1984 and advanced by Egger et al. [1] they have been used to assess the existence of publication bias in systematic reviews and meta-analyses. Spiegelhalter [2] helpfully discussed the use of funnel plots to compare institutional performance and noted the advantages of being readily interpretable, avoidance of spurious institutional ranking and allowance for variability of institutions with small volume and the relationship between outcome and volume to be assessed.

The year 2013 has seen the ‘landmark’ publication by the Healthcare Quality Improvement Partnership (HQIP) entitled ‘Everyone counts: offer 2′ followed by publication of surgeon level data on bariatric, cardiac, colo-rectal, head and neck, orthopaedic, thyroid and endocrine, upper GI, urological and vascular surgery [3]. Surgeons had the option not to consent to data publication, but their names and reason