Mortality data in adult cardiac surgery for named surgeons: retrospect
http://www.100md.com
《英国医生杂志》
1 South Manchester University Hospital, Manchester M23 9LT
Correspondence to: B Bridgewater ben.bridgewater@smuht.nwest.nhs.uk
The north west quality improvement programme in cardiac interventions is a regional consortium involving all four NHS centres that perform cardiac surgery and percutaneous coronary interventions in adults in north west England.7 We have collected prospective data on all patients undergoing cardiac surgery since 1 April 1997, including preoperative and operative variables, to enable a predicted mortality to be calculated. Data were collected in each institution and returned to a central source for analysis. Validation of data was conducted in each centre. Mortality was defined as any postoperative death in hospital during the admission for surgery.
For this analysis we looked at all patients undergoing surgery between 1 April 2001 and 31 March 2004, including patients undergoing private surgery within the NHS hospitals but excluding waiting list initiative and private practice cases undertaken outside the NHS hospitals. For this analysis we have reported outcomes for isolated first time coronary artery surgery and isolated first time aortic valve surgery. To adjust for predicted risk we have used a well accepted risk prediction algorithm, the EuroSCORE.8 If a factor necessary to calculate the score was missing in a record, we assumed that factor to be absent (this occurred in less than 2% of cases). To present the data we have subdivided the cases into low risk (score 5) and high risk (score 6) groups.9 10 To compare mortality with national data we used funnel plots with exact (Clopper-Pearson) 99% control limits.11 All analysis was performed with SAS for Windows version 8.2.
Results
Learning from Bristol: the report of the public inquiry into children's heart surgery at the Bristol Royal Infirmary 1984-1995. www.bristol-inquiry.org.uk (accessed 26 Jan 2004).
Keogh BE, Kinsman R. Fifth national adult cardiac surgical database report 2003. Henley on Thames: Dendrite Clinical Systems, 2004.
Keogh B, Spiegelhalter D, Bailey A, Roxburgh J, Magee P, Hilton C. The legacy of Bristol: public disclosure of individual surgeons' results. BMJ 2004;329: 450-4.
Shipman Inquiry. Fifth report: safeguarding patients: lessons from the past—proposals for the future. www.the-shipman-inquiry.org.uk/fifthreport.asp (accessed 26 Jan 2004).
Blackstone EH. Monitoring surgical performance. J Thorac Cardiovasc Surg 2004;128: 807-10.
Burack JH, Impellizzeri P, Homel P, Cunningham JN Jr. Public reporting of surgical mortality: a survey of New York State cardiothoracic surgeons. Ann Thorac Surg 1999;68: 1195-2000.
Northwest quality improvement programme in cardiac interventions. www.nwheartaudit.nhs.uk (accessed 26 Jan 2004).
Roques F, Nashef SA, Michel P, Guaducheau E, de Vincentiis C, Baudet E, et al. Risk factors and outcome in European cardiac surgery; analysis of the EuroSCORE multinational database of 19,030 patients. Eur J Cardiothorac Surg 1999;15: 816-23.
Bridgewater B, Grayson AD, Jackson M, Brooks N, Grotte GJ, Keenan DJ, et al. Surgeon specific mortality in adult cardiac surgery: comparison between crude and risk stratified data. BMJ 2003;327: 13-7.
Nashef SA, Roques F, Michel P, Gauducheau E, Lemeshow S, Salamon R, the EuroSCORE study group. European system for cardiac operative risk evaluation (EuroSCORE). Eur J Cardiothorac Surg 1999;16: 9-13.
Clopper CJ, Pearson ES. The use of confidence or fiducial limits illustrated in the case of the binomial. Biometrika 1934;26: 404-13.
Stark J, Gallivan S, Longrove J, Hamilton JR, Monro JL, Pollock, JC, et al. Mortality rates after surgery for congenital heart defects in children and surgeon's performance. Lancet 2000;355: 1004-7.
Chassin MR. Improving the quality of care. Part 3: improving the quality of care. N Engl J Med 1996;335: 1060-3.
Hannan EL, Siu AL, Kumar D, Racz M, Pryor DB, Chassin MR. Assessment of coronary artery bypass graft surgery performance in New York. Is there a bias against taking high-risk patients? Med Care 1997;35: 49-56.
((Ben Bridgewater, consultant surgeon1, fo)
Correspondence to: B Bridgewater ben.bridgewater@smuht.nwest.nhs.uk
The north west quality improvement programme in cardiac interventions is a regional consortium involving all four NHS centres that perform cardiac surgery and percutaneous coronary interventions in adults in north west England.7 We have collected prospective data on all patients undergoing cardiac surgery since 1 April 1997, including preoperative and operative variables, to enable a predicted mortality to be calculated. Data were collected in each institution and returned to a central source for analysis. Validation of data was conducted in each centre. Mortality was defined as any postoperative death in hospital during the admission for surgery.
For this analysis we looked at all patients undergoing surgery between 1 April 2001 and 31 March 2004, including patients undergoing private surgery within the NHS hospitals but excluding waiting list initiative and private practice cases undertaken outside the NHS hospitals. For this analysis we have reported outcomes for isolated first time coronary artery surgery and isolated first time aortic valve surgery. To adjust for predicted risk we have used a well accepted risk prediction algorithm, the EuroSCORE.8 If a factor necessary to calculate the score was missing in a record, we assumed that factor to be absent (this occurred in less than 2% of cases). To present the data we have subdivided the cases into low risk (score 5) and high risk (score 6) groups.9 10 To compare mortality with national data we used funnel plots with exact (Clopper-Pearson) 99% control limits.11 All analysis was performed with SAS for Windows version 8.2.
Results
Learning from Bristol: the report of the public inquiry into children's heart surgery at the Bristol Royal Infirmary 1984-1995. www.bristol-inquiry.org.uk (accessed 26 Jan 2004).
Keogh BE, Kinsman R. Fifth national adult cardiac surgical database report 2003. Henley on Thames: Dendrite Clinical Systems, 2004.
Keogh B, Spiegelhalter D, Bailey A, Roxburgh J, Magee P, Hilton C. The legacy of Bristol: public disclosure of individual surgeons' results. BMJ 2004;329: 450-4.
Shipman Inquiry. Fifth report: safeguarding patients: lessons from the past—proposals for the future. www.the-shipman-inquiry.org.uk/fifthreport.asp (accessed 26 Jan 2004).
Blackstone EH. Monitoring surgical performance. J Thorac Cardiovasc Surg 2004;128: 807-10.
Burack JH, Impellizzeri P, Homel P, Cunningham JN Jr. Public reporting of surgical mortality: a survey of New York State cardiothoracic surgeons. Ann Thorac Surg 1999;68: 1195-2000.
Northwest quality improvement programme in cardiac interventions. www.nwheartaudit.nhs.uk (accessed 26 Jan 2004).
Roques F, Nashef SA, Michel P, Guaducheau E, de Vincentiis C, Baudet E, et al. Risk factors and outcome in European cardiac surgery; analysis of the EuroSCORE multinational database of 19,030 patients. Eur J Cardiothorac Surg 1999;15: 816-23.
Bridgewater B, Grayson AD, Jackson M, Brooks N, Grotte GJ, Keenan DJ, et al. Surgeon specific mortality in adult cardiac surgery: comparison between crude and risk stratified data. BMJ 2003;327: 13-7.
Nashef SA, Roques F, Michel P, Gauducheau E, Lemeshow S, Salamon R, the EuroSCORE study group. European system for cardiac operative risk evaluation (EuroSCORE). Eur J Cardiothorac Surg 1999;16: 9-13.
Clopper CJ, Pearson ES. The use of confidence or fiducial limits illustrated in the case of the binomial. Biometrika 1934;26: 404-13.
Stark J, Gallivan S, Longrove J, Hamilton JR, Monro JL, Pollock, JC, et al. Mortality rates after surgery for congenital heart defects in children and surgeon's performance. Lancet 2000;355: 1004-7.
Chassin MR. Improving the quality of care. Part 3: improving the quality of care. N Engl J Med 1996;335: 1060-3.
Hannan EL, Siu AL, Kumar D, Racz M, Pryor DB, Chassin MR. Assessment of coronary artery bypass graft surgery performance in New York. Is there a bias against taking high-risk patients? Med Care 1997;35: 49-56.
((Ben Bridgewater, consultant surgeon1, fo)