Dramatic fall in heart op deaths
“One of the benefits we are now seeing from public reporting of outcomes is not just about bringing poor performers ‘into the pack’ but improving the performance of the pack as a whole. The very act of auditing services brings about improvements as centres learn from one another.”
Ben Bridgwater
UHSM surgeon and report author
“We warmly welcome this report, which shows that cardiac surgery continues to lead the way in outcome measurement in the UK. This report provides invaluable information not just in terms of the numbers of people who have benefited but also tells us about improvements in the effectiveness of treatment, patient safety and patient experience. I am particularly pleased that the evidence shows we are treating more people successfully in older age. This report provides an example of how services can put quality at the heart of everything they do.”
Professor Roger Boyle
National Director for Heart
Disease and Stroke, Department of Health
“This new report proves that open reporting works if well funded and led by the clinicians. All branches of surgery are following the trail on reporting outcomes that cardiac surgeons have blazed and this should spur those efforts on. All of medicine should take note of the findings that full audit has not resulted in risk-averse behaviour.”
John Black
President of the Royal College of Surgeons
A new national report written by one of UHSM's outstanding surgeons shows outcomes for adult cardiac patients have improved dramatically over the past five years even as more elderly and high risk patients are now being treated.
The comprehensive study of over 400,000 operations has prompted the call for all surgical specialties to follow the lead as soon as possible.
The 450 page report, entitled Demonstrating Quality: The Sixth National Adult Cardiac Surgical Database Report, conclusively proves wrong critics who suggested that publishing mortality data would lead to risk-averse behaviour from surgeons, with the most sick and elderly patients being turned down for surgery for fear of blotting statistics. In practice, the opposite has turned out to be true – the increase in reliable data has empowered surgeons to take on more complicated cases. More people who would have been considered too sick to undergo an operation just five years ago are now routinely treated and doing well.
However the report shows that women heart patients face twice the risk, and although averall death rates are falling, the gap between the survival of male and female patients may be getting bigger.
Experts say the findings provide compelling evidence that, since national publication of death rates in cardiac surgery began in 2001, the quality of care for patients has improved. These include:
- Mortality rates for ‘coronary artery surgery’ have fallen by 21 per cent and for ‘isolated valves’ by a third. For elective surgery in the under-70s mortality rate for ‘coronary artery surgery’ is now less than one per cent
- The proportion of elderly patients being seen for surgery has increased. One in five ‘coronary artery bypass’ patients were over 75 and five per cent over 80 years old. The average age of aortic valve replacement patients has increased from 61 in 1994 to 68 in 2008.
- More diabetic, high blood pressure and overweight or obese patients are having cardiac surgery, all known risk factors, yet overall operation mortality rates continue to fall
- Between 2001 and 2008 there has been a 50 per cent increase in the proportion of coronary surgery patients who are diabetic
- Between 2001 and 2008 the proportion of coronary patients with hypertension (high blood pressure) has increased from less than 60 per cent of cases to nearly 75 per cent
- Redo operations (for bleeding or deep sternal wound infection) are rare and getting rarer. The re-do rate for bleeding fell from 3.8 to 3.2 per cent between 2004 and 2008 and for infection from 0.8 per cent to 0.6 per cent over the same period and the time between first and second operations is increasing, indicating that the grafts are lasting longer
- More than twice as many people are now having ‘aortic valve replacement’ and ‘mitral valve operation’. Both these procedures are more commonly required for more elderly patients and this increase reflects the increasing life expectancy for those with heart disease
The full analysis of so many operations gives a complete breakdown of how cardiac surgery is developing and highlights areas for future improvement including unequal access to cardiac surgery across the UK.