NHS heart surgery patients in England and Wales have a greater chance of survival and recover more quickly than almost anywhere in Europe according to the first ever comparative study of cardiac operations data from across the continent, published today (25 November 2010).
The figures, which track over one million cardiac operations from 23 countries, reveal that despite carrying out a high proportion of urgent operations and treating some of the oldest patients in Europe, mortality rates in England and Wales are significantly better than expected and some 25 percent lower than the European average. The report also shows that hospital stays in England and Wales are around 10 per cent shorter than the European average, translating to direct savings to the NHS in bed days of around £6.4m for coronary artery bypass surgery (CABG) alone. The Society for Cardiothoracic Surgery in Great Britain and Ireland says that these achievements reflect the investment in quality improvement by cardiac surgeons in the UK.
England and Wales’ consistently above average results are all the more impressive given that together they are by far the most comprehensive contributor of data; almost a third of all operations in the database are English. This provides further evidence that the collection, analysis and publication of this type of data improves quality of patient care. Overall, the report demonstrates that quality of cardiac surgery is consistently improving, with mortality rates declining across the continent, but with some national variations in both care quality and access to treatment between contributing countries (as well as all major EU countries, the report also includes data from China and Hong Kong). The findings show:
- The database average risk adjusted mortality for coronary artery bypass graft surgery (CABG) is 2.4 percent. In comparison:
- Wales has a mortality rate of just 1.1 per cent
- England has a mortality rate of 1.8 per cent
- Scotland has a mortality rate of 2.2 per cent
- The database average length of in-hospital stay is 10 days. In comparison both England and Wales are less than nine days.
- Around 50 per cent of patients in England leave hospital within six days compared with around seven days in Spain and around nine days in Germany.
Surgeons say that this equates to direct savings in bed days of approximately £6.4million to the NHS from CABG operations alone, of which there were 19,660 carried out in England and Wales in 2008.*
These figures come despite the fact that the NHS is operating on some of the most elderly patients in Europe – England operates on the fifth oldest population in Europe, with urgent surgery accounting for around a third of patients in England and over half of all patients in Wales having CABG surgery.
The fourth Adult Cardiac Surgical Database Report, complied on behalf of the European Association for Cardiothoracic Surgery, contains new data from over 400,000 operations across Europe, China and Hong Kong, with England being the greatest contributor with nearly 72,000 cases in this round and 344,000 in total. In contrast countries including France, Denmark, The Netherlands, Austria and the Czech Republic have submitted no data in this round.
David Taggart, President of the Society for Cardiothoracic Surgery in Great Britain and Ireland, said: “UK cardiac surgeons are very proud of the fact that they publish the most comprehensive cardiac surgery data in Europe. This not only demonstrates a strong commitment to quality and transparency but also provides enormous reassurance for patients. The results confirm that cardiac surgery in the UK is amongst the very best in Europe and that mortality rates have fallen by half over the past five years as a direct result of the collection, analysis and publication of outcome data. Our European partners should be encouraged that this approach is likely to lead to a similar improvement in results.”
John Black, President of the Royal College of Surgeons, said: “This excellent data is the culmination of years of hard work carried out by NHS cardiac units. As a result of the profession’s dedication we are now leaders in Europe in the measurement of quality and outcomes of cardiac surgery, an achievement I am sure all other surgical specialties will wish to emulate.”
Peter Walton, Managing Director of Dendrite Clinical Systems, said: “Not only does the UK lead Europe in clinical data collection and publication of outcomes, but also the data management and reporting methodology behind the EACTS database has been developed by Dendrite, a wholly British team, and this is being adopted by major G20 economies around the world including the USA, China and Saudi Arabia. This is a British export success story"
The full EU aggregated report, lead by Ben Bridgewater, Cardiac Surgeon at University Hospitals South Manchester, and published by Dendrite Clinical Systems Ltd, gives a complete breakdown of how cardiac surgery is developing across the UK, Europe, China and Hong Kong and highlights areas for future improvement. Bespoke reports are also available for England and Wales at www.scts.org.
Notes to Editors
1. * based on figures from the Society for Cardiothoracic Surgeons (SCTS) Sixth National Adult Cardiac Surgical Database 2008 showing that there were 19660 CABG procedures carried out in England and Wales in 2008 and from the Department of Health’s 2009/2010 National Tariff .
2. The Fourth EACTS Adult Cardiac Surgery Database Report, published by Dendrite Clinical Systems, has analyses based on just over one million cardiac surgical operations from 366 hospitals based in 29 countries. The report demonstrates regional and country-specific variations and global trends in some important determinants of patient outcomes. There are also references to and comparisons against World Health Organisation data. To see an extract or purchase the report.
3. The Royal College of Surgeons of England is committed to enabling surgeons to achieve and maintain the highest standards of surgical practice and patient care. Registered charity number: 212808. For more information please visit www.rcseng.ac.uk
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