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Mortality rates after surgery for congenital heart defects in children and surgeons' performance.

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Title: Mortality rates after surgery for congenital heart defects in children and surgeons' performance.
Authors: Stark J (AUTHOR), Gallivan S (AUTHOR), Lovegrove J (AUTHOR), Hamilton JRL (AUTHOR), Monro JL (AUTHOR), Pollock JCS (AUTHOR), Watterson KG (AUTHOR), Stark, J (AUTHOR), Gallivan, S (AUTHOR), Lovegrove, J (AUTHOR), Hamilton, J R (AUTHOR), Monro, J L (AUTHOR), Pollock, J C (AUTHOR), Watterson, K G (AUTHOR)
Source: Lancet. 3/18/2000, Vol. 355 Issue 9208, p1004-1007. 4p.
Abstract: Background: A public inquiry into surgery for paediatric congenital heart defects in Bristol, UK, underscored the need for reliable data on overall mortality rates, which would allow assessment of individual surgeons' performance. We aimed to gather and report such data for 1 year to provide information for clinicians, researchers, policy makers, and the general public.Methods: We collected data on all operations (1378) for congenital heart defects done by 11 surgeons in five departments in the UK between April 1, 1997, and March 31, 1998. These operations represented about 36% of all operations done in the UK during that time. Clearly defined criteria were agreed to classify operations into subgroups.Findings: The overall mortality rate for all operations was 4.0% (95% CI 3.0-5.2). No deaths occurred for 67 arterial-switch operations. Mortality rates for coarctation, ventricular septal defect, atrioventricular septal defect, Fallot, and truncus arteriosus operations were 1.1%, 0.6%, 3.6%, 2.3%, and 28.6%, respectively. Although overall mortality rates between surgeons varied (1.6-6.9%), no surgeon's were higher than the 95% CI. The numbers of operations done by individual surgeons were small, which led to wide confidence intervals and made the detection of differences in performance difficult.Interpretation: The participating departments seemed to reach high standards of care for children with congenital heart defects, although more data would be needed to assess performance of individual surgeons. The development of quality standards will be difficult because of the complexity of defects, the different types of operations, and few patients in each subgroup. Collection of larger sets of data for more patients and centres are needed. [ABSTRACT FROM AUTHOR]
Copyright of Lancet is the property of Lancet and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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  Data: Mortality rates after surgery for congenital heart defects in children and surgeons' performance.
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  Data: <searchLink fieldCode="AR" term="%22Stark+J%22">Stark J</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Gallivan+S%22">Gallivan S</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Lovegrove+J%22">Lovegrove J</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Hamilton+JRL%22">Hamilton JRL</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Monro+JL%22">Monro JL</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Pollock+JCS%22">Pollock JCS</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Watterson+KG%22">Watterson KG</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Stark%2C+J%22">Stark, J</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Gallivan%2C+S%22">Gallivan, S</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Lovegrove%2C+J%22">Lovegrove, J</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Hamilton%2C+J+R%22">Hamilton, J R</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Monro%2C+J+L%22">Monro, J L</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Pollock%2C+J+C%22">Pollock, J C</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Watterson%2C+K+G%22">Watterson, K G</searchLink> (AUTHOR)
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  Data: <searchLink fieldCode="JN" term="%22Lancet%22">Lancet</searchLink>. 3/18/2000, Vol. 355 Issue 9208, p1004-1007. 4p.
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  Data: <bold>Background: </bold>A public inquiry into surgery for paediatric congenital heart defects in Bristol, UK, underscored the need for reliable data on overall mortality rates, which would allow assessment of individual surgeons' performance. We aimed to gather and report such data for 1 year to provide information for clinicians, researchers, policy makers, and the general public.<bold>Methods: </bold>We collected data on all operations (1378) for congenital heart defects done by 11 surgeons in five departments in the UK between April 1, 1997, and March 31, 1998. These operations represented about 36% of all operations done in the UK during that time. Clearly defined criteria were agreed to classify operations into subgroups.<bold>Findings: </bold>The overall mortality rate for all operations was 4.0% (95% CI 3.0-5.2). No deaths occurred for 67 arterial-switch operations. Mortality rates for coarctation, ventricular septal defect, atrioventricular septal defect, Fallot, and truncus arteriosus operations were 1.1%, 0.6%, 3.6%, 2.3%, and 28.6%, respectively. Although overall mortality rates between surgeons varied (1.6-6.9%), no surgeon's were higher than the 95% CI. The numbers of operations done by individual surgeons were small, which led to wide confidence intervals and made the detection of differences in performance difficult.<bold>Interpretation: </bold>The participating departments seemed to reach high standards of care for children with congenital heart defects, although more data would be needed to assess performance of individual surgeons. The development of quality standards will be difficult because of the complexity of defects, the different types of operations, and few patients in each subgroup. Collection of larger sets of data for more patients and centres are needed. [ABSTRACT FROM AUTHOR]
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  Data: <i>Copyright of Lancet is the property of Lancet and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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              Text: 3/18/2000
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