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Heart surgeons in the United Kingdom have raised the standards expected of them, figures published last week by the Healthcare Commission show.
The data on survival of patients after heart surgery, issued by the independent healthcare regulator in England, cover 38 of the 39 hospitals in the UK that carry out major heart surgery (St Mary's Hospital, London, was unable to supply the data in the format required). The figures show that 96.5% of the 35064 patients who underwent any kind of heart surgery in the year to March 2006 survived (left the hospital alive).
The commission looked in particular at survival of patients after the two most common heart operations: heart bypass and aortic valve replacement.
Survival after heart bypass operations remained better than expected, said the commission. In the UK 20773 such operations were performed between April 2005 and March 2006. Of these patients 98.4% survived, above the expected range of 97.7% to 98.3%.
The survival rate of 98% among the 3504 patients undergoing aortic valve replacement operations was within the expected range of 96.6% to 98.2%.
The overall survival rate was similar to the 96.6% seen in the previous year.
The main change this year is in what the website shows as an expected standard alongside the actual survival data for individual hospitals. The site compares actual survival with a predicted rate calculated from patients' characteristics, so that hospitals or surgeons who take more difficult cases are not disadvantaged. This year a new and more exacting UK algorithm that gives higher expected survival rates has been added to the Euroscore model that was used last year.
“We chose the Euroscore by consensus because it is a model that was already widely used in the UK and had been validated in Europe,” said Bruce Keogh, a member of the board of commissioners at the Healthcare Commissioner and president of the Society for Cardiothoracic Surgery in Great Britain and Ireland, which was involved in publishing the data.
“However,” Professor Keogh added, “the model was developed in the early 1990s. It is still valuable and works quite well in some parts of Europe, but we noticed that it was significantly over-predicting mortality in the UK.
“So what we have done is recalibrated the European model based on contemporary UK performance. Even when we did that we found that there are no outliers in terms of surgical performance in the UK.”
Whereas the predicted range of survival after heart bypass operations in the older Euroscore model—still listed on the website as the EU standard—is 95.4% to 96.3%, the new UK adjusted model gave an expected range of 97.7% to 98.3%.
The Healthcare Commission first published cardiac surgery survival data on its website last year to help patients make more informed choices about their care.
“What it really tells us is that over the last few years there has been a significant improvement in the quality of care in the specialty,” Professor Keogh said.
The website also lists individual figures for 70% of the surgeons. “Some people still have doubts about publishing results at an individual level, particularly in settings that depend heavily on cohesive teamwork,” Professor Keogh said.
“But we have been pleasantly surprised by the response that we have had from the media. One of the big fears about publishing individual surgeons' data was that the media might have been interested only in finding the worst surgeon, but that hasn't happened.”
The UK rates of survival after heart surgery are at http://heartsurgery.healthcarecommission.org.uk.