Has the publication of cardiac surgery outcome data been associated with changes in practice in Northwest England? An analysis of 25,730 patients undergoing CABG surgery under 30 surgeons over 8 years

Ben Bridgewater ^1*, Antony Grayson ², Nicholas Brooks ¹, Geir Grotte ³, Brian Fabri ², John Au ⁴, Tim Hooper ¹, Mark Jones ¹ and Bruce Keogh ⁵

¹ South Manchester University Hospitals Trust, United Kingdom
² Cardiothoracic Centre, Liverpool, United Kingdom
³ Manchester Royal Infirmary, United Kingdom
⁴ Blackpool Victoria Hospital, United Kingdom
⁵ The Heart Hospital, London, United Kingdom

^* To whom correspondence should be addressed. E-mail: ben.bridgewater{at}smuht.nwest.nhs.uk.

Accepted 5 December 2006

Abstract

Objectives To study changes in coronary artery surgery practice in the years spanning publication of cardiac surgery mortality data in the UK.

Design Retrospective analysis of prospectively collected data.

Setting All NHS centres undertaking adult cardiac surgery in Northwest England

Patients All patients undergoing first time coronary artery surgery between April 1997 and March 2005.

Main Outcome measures We have studied changes in observed, predicted and risk adjusted mortality (EuroSCORE). We have looked for evidence of risk adverse behaviour by examining the number of low (EuroSCORE 0-5), high (6-10) and very high risk patients (11 or more) under going surgery before and after public disclosure.

Results 25,730 patients underwent coronary artery surgery during the study period. The observed mortality decreased from 2.4% in 1997/98 to 1.8% in 2004/05 (p=0.014). The expected mortality (EuroSCORE) increased from 3.0 to 3.5 (p<0.001). The observed to expected mortality ratio decreased from 0.8 to 0.51 (p<0.05). The total number and percentage of patients who were low risk, high risk and very high risk were 2694 (84.6%), 449 (14.1%) and 41 (1.3%) prior to and 2654 (81.7%), 547 (16.8%) and 47 (1.4%) since public disclosure, demonstrating a significant increase in the number and proportion of high risk patients undergoing surgery (p<0.001).

Conclusions Publication of cardiac surgery mortality data in the UK has been associated with decreased risk adjusted mortality on retrospective analysis of a large patient database. There is no evidence of decreased numbers of high risk patients undergoing surgery because mortality rates are published.

Keywords: Cardiac Surgery, Clincial outcomes, Public disclosure

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