ArticleThe Lancet regional health. Europe2021
Disparity in clinical outcomes after cardiac surgery between private and public (NHS) payers in England.
Article in The Lancet regional health. Europe, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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Who cites it
10 citing papers in PubMed.
- The risk of central line-associated bloodstream infection between internal jugular and subclavian sites in critically ill patients: a multicenter cohort study.BMC infectious diseases · 2026Observational
- Comparative analysis of cardiac surgical outcomes across different healthcare funding modalities: a comprehensive cohort study.Indian journal of thoracic and cardiovascular surgery · 2025Article
- Microplastics in cardiopulmonary bypass: quantification and characterization of particles across systems.Interdisciplinary cardiovascular and thoracic surgery · 2025Article
- Socioeconomic deprivation is associated with worse in-hospital survival after isolated coronary artery bypass grafting in the UK.Interdisciplinary cardiovascular and thoracic surgery · 2025Article
- The Health Impact of Waiting for Elective Procedures in the NHS in England: A Modeling Framework Applied to Coronary Artery Bypass Graft and Total Hip Replacement.Medical decision making : an international journal of the Society for Medical Decision Making · 2024Article
- Machine learning applied to a Cardiac Surgery Recovery Unit and to a Coronary Care Unit for mortality prediction.Journal of clinical monitoring and computing · 2022Article
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- Daytime and outcomes after cardiac surgery: Systematic review and metaanalysis, insights from a large UK database review and post-hoc trial analysis.The Lancet regional health. Europe · 2021Article
- Paying for better care?The Lancet regional health. Europe · 2021Article
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Authors and funding
14 authors.
Funding
Abstract
backgroundThere is little known about how payer status impacts clinical outcomes in a universal single-payer system such as the UK National Health Service (NHS). The aim of this study was to evaluate the relationship between payer status (private or public) and clinical outcomes following cardiac surgery from NHS providers in England.
methodsThe National Adult Cardiac Surgery Audit (NACSA) registry was interrogated for patients who underwent adult cardiac surgery in England from 2009 to 2018. Information on socioeconomic status were provided by linkage with the Iteration of the English Indices of Deprivation (IoD). The primary outcome was in-hospital mortality. Secondary outcomes included incidence of in-hospital postoperative cerebrovascular accident (CVA), renal dialysis, sternal wound infection, and re-exploration. To assess whether payer status was an independent predictor of in-hospital mortality, binomial generalized linear mixed models (GLMM) were fitted along with 17 items forming the EuroSCORE and the IoD domains.
findingsThe final sample consisted of 280,209 patients who underwent surgery in 31 NHS hospitals in England from 2009 to 2018. Of them, 5,967 (2.1%) and 274,242 (97.9%) were private and NHS payers respectively. Private payer status was associated with a lower risk of in-hospital mortality (OR 0.79; 95%CI 0.65 - 0.97;
interpretationIn conclusion, using a national database, we have found evidence of significant beneficial effect of payer status on hospital outcomes following cardiac surgery in favour of private payers regardless their socioeconomic factors.
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