ArticleBMJ (Clinical research ed.)2007
Comparison of hospital episode statistics and central cardiac audit database in public reporting of congenital heart surgery mortality.
Article in BMJ (Clinical research ed.), 2007. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 1 of them a synthesis that pooled it.
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18 citing papers in PubMed, 1 synthesis or guideline pooled it.
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- The impact of shortened postgraduate surgical training on colorectal cancer outcome.International journal of colorectal disease · 2014Article
- How not to tell parents about their child's new diagnosis of congenital heart disease: an Internet survey of 841 parents.Pediatric cardiology · 2014Article
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- Laparoscopic versus open repair of inguinal hernia: a longitudinal cohort study.Surgical endoscopy · 2013Article
- Defining upper gastrointestinal bleeding from linked primary and secondary care data and the effect on occurrence and 28 day mortality.BMC health services research · 2012Article
- Surgical research and activity analysis using Hospital Episode Statistics.Annals of the Royal College of Surgeons of England · 2012Article
- Hospital mortality under surgical care.Annals of the Royal College of Surgeons of England · 2011Article
- Laparoscopic and conventional appendicectomy in children: outcomes in English hospitals between 1996 and 2006.Pediatric surgery international · 2008Article
- Surgical mortality: Media attack.BMJ (Clinical research ed.) · 2007Article
- Surgical mortality: Hospital episode statistics v central cardiac audit database.BMJ (Clinical research ed.) · 2007Article
- Data sources and performance measurement.BMJ (Clinical research ed.) · 2007Article
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Abstract
objectiveTo verify or refute the value of hospital episode statistics (HES) in determining 30 day mortality after open congenital cardiac surgery in infants nationally in comparison with central cardiac audit database (CCAD) information.
designExternal review of paediatric cardiac surgical outcomes in England (HES) and all UK units (CCAD), as derived from each database.
settingCongenital heart surgery centres in the United Kingdom. DATA SOURCES: HES for congenital heart surgery and corresponding information from CCAD for the period 1 April 2000 to 31 March 2002. HES was restricted to the 11 English centres; CCAD covered all 13 UK centres.
main outcome measureMortality within 30 days of open heart surgery in infants aged under 12 months.
resultsIn a direct comparison for the years when data from the 11 English centres were available from both databases, HES omitted between 5% and 38% of infants operated on in each centre. A median 40% (range 0-73%) shortfall occurred in identification of deaths by HES. As a result, mean 30 day mortality was underestimated at 4% by HES as compared with 8% for CCAD. In CCAD, between 1% and 23% of outcomes were missing in nine of 11 English centres used in the comparison (predominantly those for overseas patients). Accordingly, CCAD mortality could also be underestimated. Oxford provided the most complete dataset to HES, including all deaths recorded by CCAD. From three years of CCAD, Oxford's infant mortality from open cardiac surgery (10%) was not statistically different from the mean for all 13 UK centres (8%), in marked contrast to the conclusions drawn from HES for two of those years.
conclusionsHospital episode statistics are unsatisfactory for the assessment of activity and outcomes in congenital heart surgery. The central cardiac audit database is more accurate and complete, but further work is needed to achieve fully comprehensive risk stratified mortality data. Given unresolved limitations in data quality, commercial organisations should reconsider placing centre specific or surgeon specific mortality data in the public domain.
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