BMJ  2007;335:759 (13 October), doi:10.1136/bmj.39318.644549.AE (published 20 September 2007)

Research

Comparison of hospital episode statistics and central cardiac audit database in public reporting of congenital heart surgery mortality

¹ Department of Cardiac Surgery, Oxford Radcliffe Hospital NHS Trust, Oxford OX3 9DU, ² Department of Paediatric Cardiology, Oxford Radcliffe Hospital NHS Trust, ³ Department of Anaesthetics, Oxford Radcliffe Hospital NHS Trust, ⁴ Department of Cardiology, Oxford Radcliffe Hospital NHS Trust

Objective To verify or refute the value of hospital episode statistics (HES) in determining 30 day mortality after open congenital cardiac surgery in infants nationally in comparison with central cardiac audit database (CCAD) information.

Design External review of paediatric cardiac surgical outcomes in England (HES) and all UK units (CCAD), as derived from each database.

Setting Congenital heart surgery centres in the United Kingdom.

Data sources HES for congenital heart surgery and corresponding information from CCAD for the period 1 April 2000 to 31 March 2002. HES was restricted to the 11 English centres; CCAD covered all 13 UK centres.

Main outcome measure Mortality within 30 days of open heart surgery in infants aged under 12 months.

Results In a direct comparison for the years when data from the 11 English centres were available from both databases, HES omitted between 5% and 38% of infants operated on in each centre. A median 40% (range 0-73%) shortfall occurred in identification of deaths by HES. As a result, mean 30 day mortality was underestimated at 4% by HES as compared with 8% for CCAD. In CCAD, between 1% and 23% of outcomes were missing in nine of 11 English centres used in the comparison (predominantly those for overseas patients). Accordingly, CCAD mortality could also be underestimated. Oxford provided the most complete dataset to HES, including all deaths recorded by CCAD. From three years of CCAD, Oxford's infant mortality from open cardiac surgery (10%) was not statistically different from the mean for all 13 UK centres (8%), in marked contrast to the conclusions drawn from HES for two of those years.

Conclusions Hospital episode statistics are unsatisfactory for the assessment of activity and outcomes in congenital heart surgery. The central cardiac audit database is more accurate and complete, but further work is needed to achieve fully comprehensive risk stratified mortality data. Given unresolved limitations in data quality, commercial organisations should reconsider placing centre specific or surgeon specific mortality data in the public domain.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Related Articles

Media attack

Stephen Westaby, Nicholas Archer, and Neil Wilson
BMJ 2007 335: 839. [Extract] [Full Text] [PDF]

Hospital episode statistics v central cardiac audit database

Paul Aylin, Alex Bottle, Paul Elliott, and Brian Jarman
BMJ 2007 335: 839. [Extract] [Full Text] [PDF]

Summary of other responses

Sharon Davies
BMJ 2007 335: 839-840. [Extract] [Full Text] [PDF]

Data sources and performance measurement

Stephen Singleton
BMJ 2007 335: 730. [Extract] [Full Text] [PDF]

Paediatric cardiac surgical mortality in England after Bristol: descriptive analysis of hospital episode statistics 1991-2002

Paul Aylin, Alex Bottle, Brian Jarman, and Paul Elliott
BMJ 2004 329: 825. [Abstract] [Full Text] [PDF]

Survival after surgery or therapeutic catheterisation for congenital heart disease in children in the United Kingdom: analysis of the central cardiac audit database for 2000-1

John L Gibbs, James L Monro, David Cunningham, and Anthony Rickards
BMJ 2004 328: 611. [Abstract] [Full Text] [PDF]

Reliability of league tables of in vitro fertilisation clinics: retrospective analysis of live birth rates • Commentary: How robust are rankings? The implications of confidence intervals

E Clare Marshall, David J Spiegelhalter, Colin Sanderson, and Martin McKee
BMJ 1998 316: 1701-1705. [Abstract] [Full Text] [PDF]

This article has been cited by other articles:

• Westaby, S., Archer, N., Wilson, N. (2007). Media attack. BMJ 335: 839-839 [Full text]  
• Aylin, P., Bottle, A., Elliott, P., Jarman, B. (2007). Hospital episode statistics v central cardiac audit database. BMJ 335: 839-839 [Full text]  
• Davies, S. (2007). Summary of other responses. BMJ 335: 839-840 [Full text]  
• Singleton, S. (2007). Data sources and performance measurement. BMJ 335: 730-730 [Full text]  

Rapid Responses:

Read all Rapid Responses

Surgical Mortality and the Media

Stephen Westaby, et al.
bmj.com, 21 Sep 2007 [Full text]

The scandal of poor quality data

stephen black
bmj.com, 26 Sep 2007 [Full text]

Comparison of hospital episode statistics and central cardiac audit database

Paul Aylin, et al.
bmj.com, 27 Sep 2007 [Full text]

Public reporting of Outcomes in Surgery: Time to reflect on Bristol?

Ashok I Handa
bmj.com, 11 Oct 2007 [Full text]

Hospital Episode Statistics (HES) as a Tool of Profiling Surgical Outcome in England: Imperfect but Indispensable

Muhammad F Dawwas
bmj.com, 17 Oct 2007 [Full text]

Routine data sets not shown to be useless

Stephen Duckett
bmj.com, 17 Oct 2007 [Full text]

Using Routine Data

Helen Thornton-Jones
bmj.com, 19 Oct 2007 [Full text]