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. 2021 Feb 12:7:259-269.
doi: 10.1016/j.xjon.2021.02.001. eCollection 2021 Sep.

Trends and outcomes for cardiac surgery in the United Kingdom from 2002 to 2016

Stuart W Grant  1 , Simon Kendall  2 , Andrew T Goodwin  2 , Graham Cooper  3 , Uday Trivedi  4 , Richard Page  5 , David P Jenkins  6
Affiliations

Trends and outcomes for cardiac surgery in the United Kingdom from 2002 to 2016

Stuart W Grant et al. JTCVS Open. .

Abstract

Objectives: Cardiac surgery has evolved significantly since the turn of the century. The objective of this study was to investigate trends in cardiac surgery activity and outcomes in the United Kingdom utilizing a mandatory national cardiac surgical clinical database in the context of a comprehensive public health care system (ie, the UK National Health Service).

Methods: Data for all cardiac surgery procedures performed between 2002 and 2016 were extracted from the UK National Adult Cardiac Surgery Audit database. Data are validated and cleaned using reproducible algorithms. Trends in activity and outcomes were analyzed by fiscal year using linear regression.

Results: A total of 534,067 procedures were performed during the study period with the number of cases per year peaking in 2008/2009 at 41,426. Despite an increase in patient age and mean logistic European System for Cardiac Operative Risk Evaluation score, the in-hospital mortality rate for all cardiac surgery has fallen from 4.0% to 2.8% (P < .001). The number of isolated coronary artery bypass graft procedures has steadily declined but the total number of valve procedures has steadily increased (both P values < .001). The number of thoracic aortic procedures performed each year has doubled (P < .001), but the incidence of redo procedures has steadily declined. The proportion of emergency and salvage procedures has remained stable.

Conclusions: This study, which covers all cardiac surgery procedures performed in the United Kingdom for fiscal years between 2002 and 2016, demonstrates that despite an increase in patient risk profile, there has been a consistent reduction in in-hospital mortality. A number of other markers associated with quality have also improved.

Keywords: AVR, aortic valve replacement; CABG, coronary artery bypass graft; EuroSCORE; EuroSCORE, European System for Cardiac Operative Risk Evaluation; LITA, left internal thoracic artery; NHS, National Health Service; PCI, percutaneous coronary intervention; SCTS, The Society for Cardiothoracic Surgery in Great Britain and Ireland; TAVI, transcatheter aortic valve implantation; activity trends; aortic valve; cardiac surgery; coronary artery bypass graft; mitral valve; mortality; patient outcomes.

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Figures

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Graphical abstract
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Decrease in UK cardiac surgery mortality despite increasing risk measured by EuroSCORE.
Figure 1
Figure 1
The total number of cardiac surgery procedures performed in the United Kingdom and Ireland between 2002 and 2016 (left y-axis) as recorded in the National Adult Cardiac Surgery Audit (NACSA) database along with the number of contributing hospitals (right y-axis) for each financial year.
Figure 2
Figure 2
Yearly incidence of pulmonary disease, extracardiac arteriopathy, and recent myocardial infarction (MI) in patients undergoing cardiac surgery in the United Kingdom and Ireland between 2002 and 2016.
Figure 3
Figure 3
Yearly incidence of moderate or severe left ventricular (LV) dysfunction in patients undergoing cardiac surgery in the United Kingdom and Ireland between 2002 and 2016.
Figure 4
Figure 4
The number of cases performed by procedural group in the United Kingdom and Ireland between 2002 and 2016 as recorded in the National Adult Cardiac Surgery Audit (NACSA) database. CABG, Coronary artery bypass grafting.
Figure 5
Figure 5
The number of aortic valve replacements and mitral valve procedures performed in the United Kingdom and Ireland between 2002 and 2016 as recorded in the National Adult Cardiac Surgery Audit Database.
Figure 6
Figure 6
A summary of the key findings from an analysis of 14 years of United Kingdom and Ireland cardiac surgery activity between 2002 and 2016. NHS, National Health Service; CABG, coronary artery bypass grafting; AVR, aortic valve replacement.
Figure 7
Figure 7
Yearly mean logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) score and observed in-hospital mortality rates for cardiac surgery procedures performed in the United Kingdom and Ireland between 2002 and 2016.
Figure 8
Figure 8
Yearly elective mitral valve repair rates and proportion of coronary artery bypass graft cases utilizing a left internal thoracic artery (LITA) graft for cardiac surgery in the United Kingdom and Ireland between 2002 and 2016.
See this image and copyright information in PMC

References

    1. Cohn L.H. Fifty years of open-heart surgery. Circulation. 2003;107:2168–2170. - PubMed
    1. English T.A., Bailey A.R., Dark J.F., Williams W.G. The UK cardiac surgical register, 1977-82. BMJ Clin Res Ed. 1984;289:1205–1208. - PMC - PubMed
    1. Keogh B.E., Dussek J., Watson D., Magee P., Wheatley D. Public confidence and cardiac surgical outcome. Cardiac surgery: the fall guy in medical quality assurance. BMJ. 1998;316:1759–1760. - PMC - PubMed
    1. Bridgewater B. Cardiac registers: the adult cardiac surgery register. Heart. 2010;96:1441–1443. - PubMed
    1. Grant S.W., Hickey G.L., Cosgriff R., Cooper G., Deanfield J., Roxburgh J., et al. Creating transparency in UK adult cardiac surgery data. Heart. 2013;99:1067–1068. - PubMed

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