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Access to heart surgery data

27th April 2006

27042006_operating_room.jpgThe Healthcare Commission and the Society for Cardiothoracic Surgery have joined forces to launch a website with information on outcomes of heart surgery. The website will give patients and the public access to survival rates from operations at heart units across England and Wales for the first time.
The Commission and the Society say the initiative is a groundbreaking advance in the provision of information about healthcare for patients.

Some 2.6 million people in the UK are affected by heart disease.  More than 30,000 people require heart surgery every year, the majority of operations being coronary artery bypass graft.

The website gives rates of survival from operations at 30 out of 33 heart units in England and Wales, with surgeons from 17 of those units choosing to provide survival rates from their operations. In June the website will be updated with information from additional units and surgeons. The three hospitals which failed to provide the Healthcare Commission with the data - St Mary's in London, Leicester's Glenfield and Morriston in Swansea - cited complications compiling risk-adjusted information.

There had been widely held concerns that simply publishing survival or death rates without any adjustments would deter surgeons from operating on higher risk patients with lower chances of survival. However, the information released makes the necessary adjustments for the fact that some patients are more likely to survive than others, depending on the type of operation and factors such as age, severity of illness and other medical problems.

The figures have been adjusted to take account of the risks involved in the surgery using the EuroSCORE model; this model covers 17 risk factors and is an internationally established method for predicting survival from cardiac surgery taking into account other factors affecting the health of the patient.

The Commission and the Society say they have tried to present the information in the most accessible form possible, consulting patients and their representatives through the British Heart Foundation. There is a survival rate for each unit or surgeon by reference to the range of performance expected.  Results falling below this range would be seen as unusual and in need of further investigation.

Looking at the whole of England and Wales, survival rates following all types of heart surgery are better than expected.  Between April 2004 and March 2005, 96.6 per cent of patients survived, well above the expected range of 93.7 per cent to 94.5 per cent.

The Commission and the Society say they believe that surgeons should decide for themselves whether to publish their individual survival rates.  Additional surgeons have already agreed to do so by the summer.

Simon Williams, of the Patients Association, said that having information on a unit by unit basis is too vague for patients, adding that they need to know what the performance of their surgeon and team is.

The Commissions plans to make more information accessible to patients and the public, most notably as part of the new annual health check of NHS trusts, which will be released in October. It plans to evaluate the success of the heart surgery website and says the initiative could provide an example of the way forward for other clinical areas.

Chairman of the Healthcare Commission, Professor Sir Ian Kennedy, said that the website is an important move in increasing information available to patients and the public about clinical outcomes, empowering them to make more informed decisions about their treatment.
The President of the Society for Cardiothoracic Surgery, Professor Sir Bruce Keogh, said that the publication of the results on the independent Healthcare Commission website reflected the move to openness, transparency and self reflection which has emerged in cardiac surgery in the UK following events at Bristol Royal Infirmary.

He added that not all surgeons have agreed to the presentation of their personal results in this first iteration, but that 'With ingenuity and constructive feedback' these concerns could be overcome.

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