BMJ 2015;350:h1779 doi: 10.1136/bmj.h1779 (Published 7 April 2015)
Page 1 of 1
Research News
RESEARCH NEWS UK death rates in children’s heart surgery have almost halved over past decade Zosia Kmietowicz The BMJ
More children survived for at least 30 days after heart surgery at the end of the past decade than at the start, an analysis has found. The death rate fell from 4.3% to 2.6% of cases.
The findings have prompted the researchers to call for a shift away from scrutinising short term survival to looking at the longer term effects of heart surgery in children, such as measures of ill health and the effect on functional capacity. Researchers from London, Glasgow, and Birmingham analysed all data submitted to the National Institute for Cardiovascular Outcomes Research on children under 16 from 2000 to 2010 inclusive. They published their findings in the online journal Open Heart.1 Mandatory reporting of children’s heart surgery outcomes was introduced in 1997 after the Bristol Royal Infirmary scandal, in which higher than expected numbers of babies died from 1984 to 1995.
The figures, wrote the researchers, “suggest that rather than turning away higher risk patients during an era when outcomes have been monitored more closely, conversely, a greater proportion of more complex patients were taken on in later years.” Overall death rates are low and falling, and they compare well with similar data from other international databases, they added.
The researchers concluded, “The very low mortality rates at 30 days must shift our focus now towards measures of morbidity, longer term survival outcomes (such as survival to 90 days or 1 year) and functional outcomes, which, although of great importance to patients and their families, are less well delineated, and furthermore may provide evidence on the comparative long term benefits of different surgical strategies and models of care.”
The analysis included a total of 36 641 episodes of surgery, corresponding to 30 041 individual patients, 5142 of whom underwent two or more surgical episodes. In around 1 in 20 (4.4%) of these episodes the child had further surgery within 30 days.
The yearly number of episodes rose from 2283 in the year 2000, to 3939 in 2009. During that time the 30 day death rate fell from 4.3% to 2.6% of cases despite the case mix becoming more complex. For example, the proportion of low weight babies increased from 8.1% in 2000 to 10.4% in 2009-10, and the proportion of those with functionally univentricular hearts increased from 13.2% to 16.3%.
For personal use only: See rights and reprints http://www.bmj.com/permissions
1
Brown KL, Crowe S, Franklin R, et al. Trends in 30 day mortality rate and case mix for paediatric cardiac surgery in the UK between 2000 and 2010. Open Heart 2015;2:e000157; doi:10.1136/openhrt-20014-000157.
Cite this as: BMJ 2015;350:h1779 © BMJ Publishing Group Ltd 2015
Subscribe: http://www.bmj.com/subscribe
Page 1 of 1
Research News
RESEARCH NEWS UK death rates in children’s heart surgery have almost halved over past decade Zosia Kmietowicz The BMJ
More children survived for at least 30 days after heart surgery at the end of the past decade than at the start, an analysis has found. The death rate fell from 4.3% to 2.6% of cases.
The findings have prompted the researchers to call for a shift away from scrutinising short term survival to looking at the longer term effects of heart surgery in children, such as measures of ill health and the effect on functional capacity. Researchers from London, Glasgow, and Birmingham analysed all data submitted to the National Institute for Cardiovascular Outcomes Research on children under 16 from 2000 to 2010 inclusive. They published their findings in the online journal Open Heart.1 Mandatory reporting of children’s heart surgery outcomes was introduced in 1997 after the Bristol Royal Infirmary scandal, in which higher than expected numbers of babies died from 1984 to 1995.
The figures, wrote the researchers, “suggest that rather than turning away higher risk patients during an era when outcomes have been monitored more closely, conversely, a greater proportion of more complex patients were taken on in later years.” Overall death rates are low and falling, and they compare well with similar data from other international databases, they added.
The researchers concluded, “The very low mortality rates at 30 days must shift our focus now towards measures of morbidity, longer term survival outcomes (such as survival to 90 days or 1 year) and functional outcomes, which, although of great importance to patients and their families, are less well delineated, and furthermore may provide evidence on the comparative long term benefits of different surgical strategies and models of care.”
The analysis included a total of 36 641 episodes of surgery, corresponding to 30 041 individual patients, 5142 of whom underwent two or more surgical episodes. In around 1 in 20 (4.4%) of these episodes the child had further surgery within 30 days.
The yearly number of episodes rose from 2283 in the year 2000, to 3939 in 2009. During that time the 30 day death rate fell from 4.3% to 2.6% of cases despite the case mix becoming more complex. For example, the proportion of low weight babies increased from 8.1% in 2000 to 10.4% in 2009-10, and the proportion of those with functionally univentricular hearts increased from 13.2% to 16.3%.
For personal use only: See rights and reprints http://www.bmj.com/permissions
1
Brown KL, Crowe S, Franklin R, et al. Trends in 30 day mortality rate and case mix for paediatric cardiac surgery in the UK between 2000 and 2010. Open Heart 2015;2:e000157; doi:10.1136/openhrt-20014-000157.
Cite this as: BMJ 2015;350:h1779 © BMJ Publishing Group Ltd 2015
Subscribe: http://www.bmj.com/subscribe
