Intended for healthcare professionals


Publishing cardiac surgery mortality rates: lessons for other specialties

BMJ 2013; 346 doi: (Published 28 February 2013) Cite this as: BMJ 2013;346:f1139
  1. Ben Bridgewater, professor124,
  2. Graeme L Hickey, researcher2,
  3. Graham Cooper, consultant3,
  4. John Deanfield, professor4,
  5. James Roxburgh, consultant5
  6. on behalf of the Society for Cardiothoracic Surgery in Great Britain and Ireland and the National Institute for Clinical Outcomes Research, UCL
  1. 1Department of Cardiothoracic Surgery, University Hospital of South Manchester, Manchester M23 9LT, UK
  2. 2Northwest Institute for BioHealth Informatics, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
  3. 3Department of Cardiothoracic Surgery, Northern General Hospital, Sheffield, UK
  4. 4National Institute for Cardiovascular Outcomes Research, Institute of Cardiovascular Science, London, UK
  5. 5Department of Cardiothoracic Surgery, St Thomas’ Hospital, London, UK
  1. Correspondence to: B Bridgewater ben.bridgewater{at}
  • Accepted 14 February 2013

The Society for Cardiothoracic Surgeons in Great Britain and Ireland has been reporting outcome data for named surgeons since 2005. Ben Bridgewater and colleagues discuss their experiences and the implications for other specialties

The National Health Service Commissioning Board recently announced that mortality rates and other outcomes of surgery will be published for 10 specialties by summer 2013.1 This comes 12 years after the public inquiry into paediatric cardiac surgery at Bristol Royal Infirmary recommended that results by clinical team should be published to drive quality and prevent failures of clinical governance.2 UK cardiac surgeons were working towards this when the Freedom of Information Act was introduced in 2005. This led to a request from the Guardian newspaper for surgeons’ outcomes from all hospitals, which were published in April 2005.3 The Society for Cardiothoracic Surgery in Great Britain and Ireland (SCTS) has published mortality rates for all NHS hospitals and about 80% of surgeons since then.4 5 This programme has been associated with clear improvements in risk adjusted mortality without obvious adverse consequences.6

The 10 specialties named by the Commissioning Board all have national registries supported by public money through the Healthcare Quality Improvement Partnership. Going from a clinical registry to healthcare provider reports sounds simple, but in practice there are several challenges to overcome. Here we report our experiences in adult cardiac surgery to help inform this process.

Collecting and analysing data

The UK National Adult Cardiac Surgery Audit is managed by the National Institute for Cardiovascular Outcomes Research, with analytical input from Manchester University supported by charitable funding. A dedicated member of the Society of Cardiothoracic Surgeons oversees a team of database managers, an audit project manager, and data analysts. The project manager liaises with hospitals and database technicians to ensure that data are uploaded and validated. …

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