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Last Updated: Saturday, 11 September, 2004, 15:47 GMT 16:47 UK
Heart op death rate 'improving'
Surgeons performing cardiac surgery
Heart surgery death rates are steadily improving, a report says
The number of heart surgery patients dying has fallen slightly despite surgeons operating on older and sicker people, a report says.

The Society of Cardiothoracic Surgeons study of more than 82,000 adult patients from 2001 to 2003 found the death rate stood at 1.8%.

Over the last decade the rate has remained static between 2% and 3%.

Significant improvements were made in treating the elderly, people with diabetes and women, it said.

The 352-page report looked at two major forms of heart operations - aortic valve and coronary bypass surgery.

It said the improvement in the mortality rate came at a time when surgeons were treating more patients of increasing complexity due to age, illness or obesity.

Overweight

In the last decade there has been a four-and-a-half fold increase in the number of patients over 75 and two thirds of patients are now classed as overweight or obese.

However, during recent years the mortality rate for over 75s fell by 35%, diabetics by nearly 3% and women, 30%. All three are considered higher risk groups.

It was also revealed surgeons were getting better at treating patients with weak hearts with the mortality rate falling by 30% in the last five years.

Society secretary James Roxburgh, a consultant cardiac surgeon at London's Guy's and St Thomas's Hospital, said the UK was a "world leader" in heart surgery.

Individual surgeon performance should be available. The government is always saying it wants choice but we are not getting it.
Michael Summers, Patients Association chairman

"It is now high time that other high volume interventional specialities demonstrated their commitment to performance review and the public presentation of this information."

Two hospitals, the Queen Elizabeth Hospital in Birmingham and the Heart Hospital in London, had a mortality rate for coronary bypass surgery above the "alarm level" but both were found to have dealt with a string of particularly complex cases.

Lowest

Glenfield Hospital in Leicester had the lowest death rate for coronary bypass surgery at 1.1% followed by London's Royal Brompton Hospital and Sheffield's Northern General Hospital, both on 1.2%, of the 39 hospitals with adult cardiac units in the UK.

For aortic valve surgery, Plymouth's Derriford Hospital had the lowest rate, 1%, just ahead of the Northern General Hospital on 1.3%.

The database included analysis of individual surgeon performance for the first time but names were not included.

Instead, the results were broken down into individual team performance.

Main findings of report
Heart surgery death rate was 1.8% for 2001 to 2003
The US rate for 2003 was 2.3%
Mortality rate for over 75s has fallen by 35% in the last five years
The death rate for diabetic patients is 2.6% down from 5.4% in 1997
Individual surgeon mortality rates varied between 0% and 5.5%
All surgeons were said to have achieved an acceptable standard

All surgeons were said to have achieved an acceptable standard with no surgeon having a mortality rate above 5.5% for the three years.

Pressure has been mounting on the society to publish tables of surgeon performance since the Bristol Royal Infirmary scandal where surgeons were found to have continued carrying out heart operations on children even though they had higher than average death rates

But report author Sir Bruce Keogh said it would be "grossly irresponsible" to publish the information as its data was not complete so risk could not be properly assessed.

Disappointment

Sir Bruce, the president elect of the society, said: "A lot of people will be disappointed. If we were to publish a breakdown now it would result in surgeons trying to improve their level in the league by avoiding high risk surgery."

Data is missing on about a third of data, covering things such as age, illnesses and history.

But Sir Bruce said he was unable to say when it would be available as it was up to the individual hospital trusts to collate.

Michael Summers, the chairman of the Patients Association, said the fall in the death rate was welcome.

But he added: "Individual surgeon performance should be available. The government is always saying it wants choice but we are not getting it.

"Patients want to know the outcomes of individual surgeons so they can make an informed choice of where to go."




SEE ALSO:
Lottery helps out heart patients
04 Mar 04  |  Health
Blair pledges NHS surgery choice
23 Jan 03  |  Health


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