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Survival after heart surgery continues to improve after publication of mortality data

BMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b3102 (Published 30 July 2009) Cite this as: BMJ 2009;339:b3102
  1. Oona Mashta
  1. 1London

    Outcomes for adult cardiac patients have improved substantially in the past five years, even though more elderly and high risk patients are now being treated. Mortality rates after coronary artery surgery have fallen by 21% and for isolated valves by a third, a study by the Society for Cardiothoracic Surgery of Great Britain and Ireland has found.

    For their report, Demonstrating Quality: The Sixth National Adult Cardiac Surgical Database, the society studied more than 400 000 operations. They found that since national publication of mortality rates in cardiac surgery began in 2001 the quality of care for patients has improved.

    Fewer than one in 100 elective surgery patients younger than 70 who undergo coronary artery die. And although more patients with risk factors are having cardiac surgery, overall mortality rates after cardiac surgery continue to fall.

    The results have prompted the Royal College of Surgeons of England to urge all surgical specialties to follow the lead as soon as possible and publish mortality data.

    The college said that although critics expected that publishing mortality data would lead to risk averse behaviour from surgeons, with the most sick and elderly patients denied surgery for fear of worsening the statistics, in practice, the opposite has turned out to be true.

    One in five coronary artery bypass patients were older than 75 and 5% older than 80 years old. The average age of patients who have aortic valve replacement has increased from 61 in 1994 to 68 in 2008. Between 2001 and 2008 there was a 50% rise in the proportion of coronary surgery patients who are diabetic, and in the same period the proportion of patients with hypertension undergoing coronary surgery rose from less than 60% of cases to nearly 75%.

    More than twice as many people are now having aortic valve replacement and mitral valve operations, which are more commonly required by more elderly patients.

    The full analysis, published jointly by the society and the company Dendrite Clinical Systems, gives a complete breakdown of how cardiac surgery is developing and highlights areas for improvement, including unequal access to cardiac surgery throughout the United Kingdom. For example, although mortality rates are improving overall, a persistent gap remains between the sexes, with survival rates worse for women than for men.

    Cardiac surgeons are looking at extending outcome reporting to other areas that affect recovery time and quality of life, such as bleeding rates, postoperative stroke, kidney failure, and the need to redo operations.

    Ben Bridgewater, consultant cardiac surgeon at the University Hospital of South Manchester and author of the report, said, “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.”

    John Black, president of the Royal College of Surgeons, said, “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.”

    The report can be purchased at www.e-dendrite.com/publications-find.php?id=17 for £100.

    Notes

    Cite this as: BMJ 2009;339:b3102

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