Heart doi:10.1136/heartjnl-2013-303671
  • Cardiovascular surgery
  • Original article

Real time monitoring of risk-adjusted paediatric cardiac surgery outcomes using variable life-adjusted display: implementation in three UK centres

Open Access
  1. Katherine Brown4
  1. 1Clinical Operational Research Unit, Department of Mathematics, University College London, London, UK
  2. 2Department of Congenital Heart Disease, Evelina Children's Hospital, St Thomas’ Hospital, London, UK
  3. 3Department of Paediatric Cardiology, The Royal Hospital for Sick Children, Glasgow, UK
  4. 4Cardio respiratory and Intensive Care Division, Great Ormond Street Hospital for Children, London, UK
  1. Correspondence to Dr Christina Pagel, Clinical Operational Research Unit, Department of Mathematics, University College London, 4 Taviton Street, London WC1H 0BT, UK; c.pagel{at}
  • Received 17 January 2013
  • Revised 7 March 2013
  • Accepted 8 March 2013
  • Published Online First 5 April 2013


Objective To implement routine in-house monitoring of risk-adjusted 30-day mortality following paediatric cardiac surgery.

Design Collaborative monitoring software development and implementation in three specialist centres.

Patients and methods Analyses incorporated 2 years of data routinely audited by the National Institute of Cardiac Outcomes Research (NICOR). Exclusion criteria were patients over 16 or undergoing non-cardiac or only catheter procedures. We applied the partial risk adjustment in surgery (PRAiS) risk model for death within 30 days following surgery and generated variable life-adjusted display (VLAD) charts for each centre. These were shared with each clinical team and feedback was sought.

Results Participating centres were Great Ormond Street Hospital, Evelina Children's Hospital and The Royal Hospital for Sick Children in Glasgow. Data captured all procedures performed between 1 January 2010 and 31 December 2011. This incorporated 2490 30-day episodes of care, 66 of which were associated with a death within 30 days.The VLAD charts generated for each centre displayed trends in outcomes benchmarked to recent national outcomes. All centres ended the 2-year period within four deaths from what would be expected. The VLAD charts were shared in multidisciplinary meetings and clinical teams reported that they were a useful addition to existing quality assurance initiatives. Each centre is continuing to use the prototype software to monitor their in-house surgical outcomes.

Conclusions Timely and routine monitoring of risk-adjusted mortality following paediatric cardiac surgery is feasible. Close liaison with hospital data managers as well as clinicians was crucial to the success of the project.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

Open Access

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