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

BMJ 2004; 329 doi: (Published 07 October 2004) Cite this as: BMJ 2004;329:825
  1. Paul Aylin (p.aylin{at}, clinical senior lecturer1,
  2. Alex Bottle, researcher1,
  3. Brian Jarman, emeritus professor1,
  4. Paul Elliott, professor of epidemiology and public health, faculty of medicine1
  1. 1 Dr Foster Unit at Imperial College London, Department of Epidemiology and Public Health, Imperial College School of Medicine, London W2 1PG
  1. Correspondence to: P Aylin
  • Accepted 4 August 2004


Objective To describe trends in mortality of open cardiac surgery in children in Bristol and England since 1991.

Design Retrospective analysis of hospital episode statistics data.

Setting All open cardiac surgery of children in England.

Population Patients younger than 16 undergoing open cardiac surgical procedures in England between April 1991 and March 2002. Three time periods were defined: epoch 3 (April 1991 to March 1995), epoch 5 (April 1996 to March 1999), epoch 6 (April 1999 to March 2002).

Main outcome measure Mortality in hospital within 30 days of a cardiac procedure.

Results We identified 5221 open operations between April 1996 and March 2002 in children under 1 year and 6385 in children aged 1-15 years. Mortality for all centres combined fell from 12% in epoch 3 to 4% in epoch 6. Mortality in children under 1 year at Bristol fell from 29% (95% confidence interval 21% to 37%) in epoch 3 to 3% (1% to 6%) in epoch 6, below the national average. The reduction in mortality did not seem to be due to fewer high risk procedures or an increase in the numbers of low risk cases. Oxford had a significantly higher mortality than the national average in all three epochs (11% (5% to 18%) in epoch 6), which was not affected by adjusting for procedure or the inclusion of cases with missing outcomes.

Conclusions At Bristol, mortality for open operations in children aged under 1 year has fallen markedly, to below the national average. Nationwide mortality has also fallen. Improved quality of care may account for the drop in mortality, through new technologies or improved perioperative and postoperative care, or both.


  • Embedded ImageAdditional figures and tables are on

    We thank Leslie Hamilton (consultant cardiac surgeon, Freeman Hospital, Newcastle upon Tyne) for his helpful comments on our draft and particularly for his advice on changing patterns of surgical and post-operative practice. We also thank Nicky Best (reader in statistics, Imperial College London) for her advice on statistical matters.

  • Contributors PA and PE were involved in the original research. PA and BJ devised this follow up work. PA and AB carried out the data extract and analyses. PA and PE drafted the paper. All investigators contributed comments on drafts.

  • Competing interests The work was funded by Dr Foster Limited. BJ served on the panel for the Bristol Royal Infirmary inquiry. PA was an expert witness for the inquiry. PE was on the statistical review panel for the inquiry.

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