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Cardiac surgical mortality: the tip of the quality assurance iceberg
  1. Secretary, Society of Cardiothoracic Surgeons of Great Britain and Ireland
  2. Coordinator, UK National Adult Surgical Database
  3. Associate Medical Director for Clinical Governance
  4. University Hospital Birmingham NHS Trust
  5. Queen Elizabeth Hospital
  6. Edgbaston, Birmingham B15 2TH, UK

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The recent hearings of the General Medical Council and the public inquiry into the “Bristol affair” have fuelled several high profile reports in the media, based on legitimate concerns that cardiac surgery, with its potentially profound adverse outcomes, was devoid of effective quality assurance. Two papers published in this issue ofHeart take us one step further in the quest for quality management in cardiac surgery. The first paper from Wynne-Jones and colleagues compares activity and outcomes from four cardiac surgical centres in the north west of England and highlights a number of important issues related to reliable data collection, validation, and risk stratification.1 The second paper, by Sherlaw-Johnson and colleagues, simplifies the complex issue of presentation and display of outcome data by adding easily understandable limits to risk adjusted outcome graphs.2

The first report describes the highly successful North West Cardiac Surgical Database initiative and demonstrates that where the professional will exists, reliable and meaningful data collection is possible using a variety of data capture models tailored to suit individual institutions. But it is also clear that whichever model is used, support is required from dedicated non-clinical staff to ensure completeness of data collection. One of the key strengths of this initiative has been the rigorous data validation employed across all four centres, and it is therefore pleasing to note that the mortalities quoted for the common adult cardiac surgical procedures are in line with those reported to the UK Cardiac Surgical Register which has been collecting unvalidated activity and mortality data from all National Health Service cardiac surgical units since 1977.

A natural progression from simple activity and mortality data is the collection of a number of variables on each and every patient undergoing surgery to enable stratification for case mix. To this end, the four …

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