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Cardiac registers: the adult cardiac surgery register
  1. Ben Bridgewater1,2 On behalf of the Society for Cardiothoracic Surgery in GB and Ireland
  1. 1University Hospital of South Manchester, Manchester, UK
  2. 2National Institute for Clinical Outcomes Research, University College, London, UK
  1. Correspondence to Mr Ben Bridgewater, SMUHT, Southmoor Road, Manchester M23 9LT, UK; ben.bridgewater{at}

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Background: reason for existence of database, when it began

The Society for Cardiothoracic Surgery (SCTS), the professional society representing cardiac and thoracic surgery in Great Britain and Ireland, has a long history of collecting and benchmarking adult cardiac surgery mortality data.1 As long ago as 1977, under the guidance of Sir Terence English, the SCTS established a cardiac surgery register whereby all units were asked to submit data to a central source for analysis. The data required were the number of operations in various specified operative groups, along with associated 30 mortality. All returns were paper based and thought to be of variable quality. The SCTS produced outputs of pooled mortality rates for the specific operations, and returned to each unit their mortality against the pooled data. There was no ability to stratify for case mix within the register.

In 1994 Bruce Keogh (now Professor Sir Bruce Keogh, NHS medical director) established a cardiac surgery database project where initially a small number of centres providing cardiac surgery care were asked to collect a more comprehensive dataset, including preoperative patient characteristics, operative details and postoperative outcomes to allow trends in surgery to be studied along with mortality outcomes; particularly of interest was to understand those outcomes against differences in case mix. A similar initiative was set up in northwest England, including a consortium of the four NHS hospitals undertaking cardiac surgery in the region. Together these projects showed that it was possible to collect and pool data from multiple hospitals using encrypted patient identifiers via software systems set up by the Central Cardiac Audit Database (CCAD, now part of the NHS Information Centre), to collect data on all patients from all hospitals in a defined geographical region and to supplement data collection with centralised analysis, governance screening processes and cooperative quality improvement methodologies. More recently the CCAD project has …

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