Mortality data in adult cardiac surgery for named surgeons: retrospective examination of prospectively collected data on coronary artery surgery and aortic valve replacement

Abstract

Objectives: To present named surgeon mortality for isolated first time coronary artery surgery and aortic valve surgery.

Design: Retrospective analysis of prospectively collected data.

Setting: All NHS hospitals undertaking adult cardiac surgery in north west England.

Participants: 25 consultant surgeons carrying out coronary artery surgery and aortic valve replacement between April 2001 and March 2004.

Main outcome measures: Mortality for both operations according to surgeon. EuroSCORE to stratify patients into low and high risk.

Results: 10,163 patients underwent surgery under 25 surgeons. The average number of patients per surgeon was 363 for coronary artery surgery and 44 for aortic valve replacement. Seventeen per cent of the patients undergoing coronary artery surgery and half of those undergoing aortic valve surgery were considered high risk. The average mortality was 1.8% (range 0-3.8%) for coronary surgery and 1.9% (0-12.5%) for aortic valve surgery. Mortality for all surgeons fell below 99% control limits of the national mean for both operations.

Conclusions: The presented mortality figures for the two cardiac operations fell within accepted limits for all surgeons. The division of outcomes according to low and high risk patients is imperfect but may help to inform the public about the complexities of this type of analysis and prevent surgeons avoiding high risk patents who may benefit from an operation.

Fig 1

Funnel plot of mortality against national data for CABG, showing mortality for each surgeon and 99% control limits

Fig 2

Funnel plot of mortality against national data for AVR, showing mortality for each surgeon and 99% control limits