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Children’s heart surgery unit at Leeds and two other centres were close to “alert” threshold, figures show

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f2423 (Published 16 April 2013) Cite this as: BMJ 2013;346:f2423
  1. Clare Dyer
  1. 1BMJ

The three year mortality rate for the children’s heart surgery unit at Leeds General Infirmary is close to the “alert” threshold, but so are two of the seven units earmarked to survive under the planned reconfiguration of services, data released by NHS England show.

The report, produced during the temporary closure of the Leeds unit after preliminary figures seemed to show high death rates there, indicates that units at the Evelina Children’s Hospital in London and Alder Hey Children’s Hospital in Liverpool are also close to the alert point.

The analysis, conducted by the National Institute for Cardiovascular Outcomes Research (NICOR), used new software designed for congenital heart disease and for the first time compared performance between units. The software relies on receiving full data from the units. The Leeds unit at first appeared to have high death rates, but this was because it had not provided full information.

The final analysis, which incorporates the missing data and has been adjusted for case mix, shows that there are no significant outliers among the 10 units in England and all are safe. “These findings do not indicate a ‘safety’ problem in any centre,” says the report. “However, centres with 3-year outcomes approaching the alert threshold may deserve additional scrutiny and monitoring of current performance.”

Three units—at Leeds, Leicester, and the Royal Brompton in London—have been recommended for closure in the Safe and Sustainable review, which is aimed at concentrating services in larger, more specialised centres.1 The NICOR analysis shows that the Brompton has one of the lowest mortality rates.

“By definition, around half of all units will have more deaths than ‘expected,’” adds the report. “It is therefore inappropriate to label centres as ‘blameworthy’ for these deaths, as the analysis does not show a significantly increased mortality rate.”

The new Partial Risk Adjustment in Surgery (PRAiS) software, which was developed at University College London, is being supplied to all 10 trusts carrying out paediatric congenital heart surgery and will enable them to continuously monitor their own performance.

Children’s heart surgery at the Leeds unit was suspended for 12 days after NICOR’s then director, Roger Boyle, sent the NHS medical director, Bruce Keogh, two graphs showing apparently higher mortality rates at Leeds (that is, before the missing data were included). These graphs have been published on the website of NHS England, along with the NICOR analysis.2

Boyle, who has been an adviser to the Safe and Sustainable review, has said that he would not take part in the next stage of the review, said a spokeswoman for NHS England. On Tuesday 16 April he also decided to step down as NICOR director.

NICOR says on its website, “NICOR has policies in place relating to analysis, communications and release of data. We will investigate whether any breach of these policies has occurred and act promptly to ensure that NICOR protocols are followed by all staff.”

Notes

Cite this as: BMJ 2013;346:f2423

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