Care Quality Commission
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Healthcare watchdog publishes latest heart surgery survival rates

Updated survival rates for surgery at 37 heart units across the UK will be published today by the Healthcare Commission.

It will release the statistics on its groundbreaking cardiac website, set up in 2006 when heart surgery became the first speciality to publish information on survival.

The data has been adjusted to take into account the age and lifestyle of patients, which affect chances of survival.

Previously, the international EuroSCORE benchmark was used as a way of taking account of the risks involved in the surgery. However, as more people are now expected to survive in the UK than when EuroSCORE was first introduced, the benchmark for the UK introduced last year is a tougher measure.

When measured against the UK model, there were no units with survival rates that were ‘worse than expected’. Thirty-two units’ survival rates are ‘as expected’, and five are ‘better than expected’. These are: Leeds General Infirmary, Moriston Hospital Swansea, Southampton General Hospital, University Hospital of Wales and Wythenshawe Hospital, Manchester.

The website gives information on over 35,000 heart operations performed between April 2006 and March 2007. The site shows survival rates from the 37 units for all heart surgery during this period. Figures for the two most common types of heart surgery: heart bypass and aortic valve
replacement, are displayed. Surgeons at 30 units have also voluntarily made available the particular survival rates of their patients.

The figures show that survival rates have remained consistently high, with no significant change from the previous year:

· The national survival rate for all types of heart operations is 96.6%. This is up by 0.1% from last year’s figure of 96.5%.

· Between April 2006 and March 2007 there were 20,474 heart bypass operations in the UK. Nationally, 98.32% of patients survived, giving an overall rating of ‘as expected’ as the figure falls within the expected UK range of 97.81% to 98.39%.

· There were 3,522 aortic valve replacement operations carried out during this period, with a survival rate of 98.01%, or ‘as expected’.

This is well within the expected UK range of 96.94% to 98.46%.

The website is a joint project between the Healthcare Commission and the Society for Cardiothoracic Surgery in Great Britain and Ireland. The site aims to increase public confidence by reassuring patients that survival rates are within acceptable levels.

Professor Sir Ian Kennedy, Chairman of the Healthcare Commission, said: “This project proves that we can successfully bring this kind of information into the public domain to the satisfaction of both patients and those who look after them.

“Some feared that surgeons may take on fewer high-risk operations, but this has not proved to be the case. In fact the opposite is true.

“It is important for other specialities to recognise the benefits to patients that making this information available brings, and to consider making information on their patients’ outcomes available.

“Making this information available has increased patients’ confidence in heart surgeons. It is a fine example for other surgical specialities to follow.”

Leslie Hamilton, President of The Society for Cardiothoracic Surgery (SCTS) said: “Cardiothoracic surgeons in the UK have worked hard to collect data on their outcomes and improve the quality of the care they give to their patients.

“The Healthcare Commission’s website shows that the quality of care in the UK is now exceptionally and uniformly good. And better than that in Europe. This confirms the findings of the recent National Confidential Enquiry into Patient Outcome and Death (NCEPOD) report, 'The Heart of the Matter'. Patients will find this data reassuring.

“SCTS believes that their example should encourage other specialties within both medicine and surgery that it is possible to present such data to the public in a meaningful way.”

Data included on the website includes:

· EuroSCORE survival rates for both heart bypass and aortic valve replacement operations for the period April 06 – March 07, and in the three years to March 07

· UK adjusted survival rates for both heart bypass and aortic valve
replacement operations for the period April 06 – March 07, and in the three years to March 07

· Survival rates for individual surgeons at 30 units.



Notes:

The cardiac website can be found at: http://heartsurgery.healthcarecommission.org.uk/

The website does not predict an individual’s chance of surviving heart surgery.

For further information contact Emma Reynolds, Press Officer, on 0207 448 9237 or on 07917 232 143 after hours.


About the two most common heart operations:



The ‘heart bypass’ surgery referred to in this press release is also known as a coronary artery bypass graft or CABG. The operation bypasses blockages or narrowings in the coronary arteries (the arteries that feed the heart muscle).


An aortic valve replacement (or AVR) operation involves taking away the aortic valve and replacing it with a new valve made either from animal tissue or from metal and carbon (mechanical).

About the EuroSCORE:


In previous years the EuroSCORE model has been used to measure survival. This is an internationally recognised system that calculates expected survival rates for heart surgery, taking into account factors such as a patient’s age and the severity of his or her illness.

This process is called ‘risk-adjustment’. This tempered concerns that simply publishing crude rates of survival or death without any such adjustments would deter surgeons from operating on patients that are higher risk.

There have been suggestions that the European model is becoming outdated given improvements in technology and surgical techniques, and this leads to the majority of hospitals achieving ‘better than expected’ survival rates. This is why the Commission started to use the tougher UK standard last year.

Because more people are expected to survive, the adjustment for UK performance is a tougher measure.

Survival rates from the previous year:

Between April 2005 and March 2006 there were 20,773 heart bypass operations in the UK: 98.4% of patients survived, above the expected range of 97.74% to 98.32%. Nationally this was ‘better than expected’ when measured against the UK standard.

A survival rate of 98.03% for the 3,504 patients undergoing aortic valve replacements was comfortably within the expected range of 96.63% to 98.20%. Nationally this was ‘as expected’ when measured against the UK standard.

Information regarding Glasgow Royal Infirmary:


Data quality issues at Glasgow Royal Infirmary means that there will be no data available on the website for this unit. It is expected that the data issues will eventually be resolved by Central Cardiac Audit Database on a case by case basis.

Glasgow Royal Infirmary and Glasgow Western Infirmary have recently merged to form the West of Scotland Regional Heart and Lung Centre based at the Golden Jubilee Hospital at Clydebank. The units at Glasgow Royal and Glasgow Western will continue to be shown on the website with their relevant data, but will note the existence of the new unit. The new unit will have its own page but will not yet display survival rate data noting that this is available on the old unit pages.

Information on the Healthcare Commission

The Healthcare Commission is the health watchdog in England. It keeps check on health services to ensure that they are meeting standards in a range of areas. The Commission also promotes improvements in the quality of healthcare and public health in England through independent, authoritative, patient-centred assessments of those who provide services.

Responsibility for inspection and investigation of NHS bodies and the independent sector in Wales rests with Healthcare Inspectorate Wales (HIW). The Healthcare Commission has certain statutory functions in Wales which include producing an annual report on the state of healthcare in England and Wales, national improvement reviews in England and Wales, and working with HIW to ensure that relevant cross-border issues are managed effectively.

The Healthcare Commission does not cover Scotland as it has its own body, NHS Quality Improvement Scotland. The Regulation and Quality Improvement Authority (RQIA) undertakes regular reviews of the quality of services in Northern Ireland.

About the Society for Cardiothoracic Surgery in Great Britain and Ireland


The Society for Cardiothoracic Surgery in Great Britain and Ireland is a registered charity that exists to encourage and promote excellence in cardiothoracic surgery. The Society has pioneered data collection in the UK, having a register of all cardiothoracic operations since 1977. The first National Adult Cardiac Surgical Database Report was produced in 2001 and in 2005 this included survival rates for cardiac surgical operations. SCTS, in collaboration with The Healthcare Commission, has made these results available to patients and the public since 2006.

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