One in 10 patients who undergo emergency operations in public hospitals die within 30 days, and nearly 40 per cent suffer complications. The Hospital Authority said these outcomes were 'good' compared with health systems overseas, and showed Hong Kong's public hospitals had a good quality of care. But what may concern the public and authorities are the performance variations among the 17 public hospitals with surgical departments, disclosed in the authority's first comprehensive audit of public surgical services. Several public hospitals with relatively poor results have been asked to improve their standards and learn from the good performers. In some cases, small hospitals outperform major hospitals. Doctors say manpower, resources, skills and hospitals' culture in clinical governance all contribute to the variations. The audit - called the surgical outcomes monitoring and improvement programme (SOMIP) - compares the performance of 17 surgical departments by checking the outcome of 21,839 major operations between July 2008 and June 2009. Of these, 22 per cent were emergency operations, the rest were elective. The audit findings have been regarded as sensitive information 'for internal use only', and have never been made known to the public. A 192-page full audit report seen by the Post says the study 'clearly identifies that there were variations in the performance of HA hospitals. These variations are particularly great in emergency operation settings. Hospital Authority head office should take the lead to examine the reasons behind the variations and facilitate improvement'. The report raises a 'red alert' on at least three public hospitals that have relatively high 30-day mortality rates for elective operations, and on four public hospitals for their relatively high 30-day mortality rate for emergency surgery. The hospitals are not named in the report. According to various sources close to the audit, the university teaching hospitals - Queen Mary in Pok Fu Lam and Prince of Wales in Sha Tin - have among the best surgical results. Those needing improvement include Tuen Mun, Princess Margaret in Kwai Chung and Yan Chai in Tsuen Wan. The audit looks at the mortality, or death rate, and the morbidity rate, which refers to serious complications such as surgical site infections, acute renal failure, strokes and other problems causing readmission. The mean 30-day mortality and morbidity rates for emergency operations are 10.9 per cent and 38.6 per cent. The figures for elective surgery are 0.6 per cent and 12.2 per cent. The authority refused to disclose which hospital was the best or the worst, but pledged to release more information when the audit had been in operation longer. 'We will definitely release more information to the public once the system is more mature,' acting director for quality and safety Dr Liu Hing-wing said. The audit results have been shared among surgeons so they can learn from the good performers. 'Now we only collect annual figures,' Liu said. 'We have to find out what is behind the differences of the hospitals; we need to get hold of at least several years' worth of figures to make sure the audit is reliable.' SOMIP director Dr Albert Yuen Wai-cheong, a consultant surgeon, said the city's surgical standards were 'good' compared with many developed health-care systems, such as those in the United States and Britain. He said a follow-up study of the audit had concluded that doctors' workload in dealing with emergency operations and the involvement of specialists were the two most important factors in the results. 'For hospitals that need to improve their standards, the audit has become a powerful tool for improvement,' Yuen said. Medical lawmaker Dr Leung Ka-lau, a part-time surgeon at Prince of Wales Hospital, said such audits were necessary. 'A clinical audit is just a first step to making improvements,' he said. 'Manpower, skills and resources all contribute to the variation of surgical performance.' Leung agreed with the authority's decision not to publish the full report. 'Members of the public do not know how to interpret the results. It would be chaotic if all patients flood the so-called well-performing hospitals.' A senior hospital executive said it was a good move for the authority to compare surgical results. 'In the past, some surgical departments always gave an excuse for their poor results, saying their patients were more complicated,' the executive said. 'This audit uses statistical methods to adjust the various risks of different departments to give a more sensible comparison. It shows the merits and demerits of different teams and it helps to uphold standards.' While the 17 hospitals have cases of different complexity, the audit uses a special mathematical model to adjust the various risks of different patients to make an 'apple to apple' comparison of hospitals.