Heart surgery can be extremely complicated Outcomes for adult cardiac patients in the UK have improved significantly since publication of information on death rates, research suggests. The study also found more elderly and high-risk patients were now being treated, despite fears surgeons would not want to take them on. It is based on analysis of more than 400,000 operations by the Society for Cardiothoracic Surgery. Experts said all surgical specialties should now publish data on death rates. DEATH RATES Coronary artery bypass surgery alone:

2001: 2.3%

2008: 1.5% All coronary artery bypass surgery:

2001: 2.6%

2008: 1.7% Heart valve surgery alone:

2001: 5.2%

2008: 3.5% Combined valve and coronary artery bypass surgery:

2001: 8.3%

2008: 6.1% It had been feared that publication of death rates, which began in 2001, would make surgeons more defensive about their work, and reluctant to take on higher-risk patients who may damage their statistics. However, the latest analysis suggests that the availability of reliable data on risk has emboldened surgeons to take on more complicated cases. It suggests that more people who would have been considered too sick to undergo an operation just five years ago are now routinely treated and doing well. For instance, one in five coronary artery bypass patients are now over 75, and the average age of aortic valve replacement patients has increased from 61 in 1994 to 68 in 2008. Between 2001 and 2008 there was a 50% increase in the proportion of coronary surgery patients who had diabetes, and the proportion who had high blood pressure increased from less than 60% to nearly 75%. However, overall operation mortality rates are continuing to fall. Big progress has been made in coronary artery surgery, with the overall death rate falling by 21%, and the death rate for people under the age of 70 undergoing planned surgery now less than 1%. The data also shows that surgeons are having to open up patients for a second time less frequently due to complications such as internal bleeding and infections. And operations associated with elderly patients, such as aortic value replacement, are becoming more common, suggesting people with heart disease are living longer. Women worse off However, the data also shows that survival rates remain significantly worse for women than men, with the gap between the sexes failing to close. It is now planned to publish more extensive data covering other aspects of patient care. We are now taking on older, sicker, higher-risk patients, and these patients, rather than doing worse because of their risk, are actually doing better than they did before

Mr Graham Venn

Cardiothoracic surgeon Mr Graham Venn, a cardiothoracic surgeon at Guy's and St Thomas' Hospital in London, said surgeons had initially been suspicious about how adverse data would be handled. But he said: "Pleasingly, the trusts and the regulatory bodies have handled this very responsibly. "When adverse trends have been identified they have usually been found to be due to system or resource issues and it has been possible to reverse these and reverse the adverse trends before they become a problem." Mr Venn said the data had also helped him pin down and explain risk to individual patients, and his team to improve planning of surgery to ensure best quality care from first to last. "It is tightening the quality of the whole system. Everybody on the team is involved, all pulling in the same way. "We are now taking on older, sicker, higher-risk patients, and these patients, rather than doing worse because of their risk, are actually doing better than they did before. Results continue to improve year on year." Raising standards Researcher Mr Ben Bridgewater, a consultant cardiac surgeon at University Hospital of South Manchester, said: "One of the benefits we are now seeing from public reporting of outcomes is not just about bringing poor performers 'into the pack' but improving the performance of the pack as a whole. "The very act of auditing services brings about improvements as centres learn from one another." Mr John Black, president of the Royal College of Surgeons said: "This new report proves that open reporting works if well funded and led by the clinicians. "All branches of surgery are following the trail on reporting outcomes that cardiac surgeons have blazed and this should spur those efforts on. "All of medicine should take note of the findings that full audit has not resulted in risk-averse behaviour." Professor Roger Boyle, the Department of Health's national director for heart disease and stroke, welcomed the findings of the study. He said: "This report provides invaluable information not just in terms of the numbers of people who have benefited but also tells us about improvements in the effectiveness of treatment, patient safety and patient experience. "I am particularly pleased that the evidence shows we are treating more people successfully in older age."



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