BMJ  2007;335:839 (27 October), doi:10.1136/bmj.39374.474965.BE

Letters

Surgical mortality

Hospital episode statistics v central cardiac audit database

We published the follow-up of the Bristol Royal Infirmary analysis to which Westaby et al refer^{1 2} and have some comments on their paper.

The online version suggests that the clinical teams did not verify the data. We wrote to the clinical team at Oxford over a year before our paper was published. After some months and a reminder letter sent to them, we received a response from the medical director of the trust which did not dispute our figures. His letter also confirmed that the trust had become aware of a downturn in their results before 2000. This was noted in our paper.

We have previously made clear the limitations of using OPCS4 codes in defining open operations, in that there is no explicit code for open heart surgery. We used a definition arrived at by consultation for the Bristol inquiry.³ Because this definition differs from that used within the central cardiac audit database (CCAD), they are not directly comparable. The Thames Valley Strategic Health Authority's report (on which Westaby et al say their report is based) came to the same conclusion.⁴

The mortality rates quoted in the Oxford paper differ importantly from the mortality figures quoted to us by the medical director of the trust. There are also differences in comparison with the official CCAD figures published on the congenital heart disease website (www.ccad.org.uk/congenital).

Paediatric cardiac surgery is a highly specialised, complex field. The Oxford paper's conclusions suggest that surgeons don't agree among themselves how best to monitor outcomes. We agree that the CCAD could potentially provide an alternative and improved data source for paediatric cardiac surgery outcomes. We also support the Thames Valley report's conclusions that hospital episode statistics and the CCAD both have an important role in measuring activity and outcomes in the clinical setting.⁴ Ideally, clinical and administrative datasets should function as one, but in any case, all clinicians should be prepared to take an active part in institutional data collection.⁵

¹ Dr Foster Unit at Imperial College, Department of Primary Care and Social Medicine, London SW7 2AZ, ² Department of Epidemiology and Public Health, Faculty of Medicine, Imperial College, London W2 1PG, ³ Dr Foster Unit at Imperial College

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Competing interests: PA, AB, and BJ are employed by Imperial College and work within the Dr Foster Unit at Imperial. The Dr Foster Unit at Imperial is funded by a research grant from Dr Foster Intelligence (an independent health service research organisation).

References

1. Westaby S, Archer N, Manning N, Adwani S, Grebenik C, Ormerod O, et al. Comparison of hospital episode statistics and the central cardiac audit database in the public reporting of congenital heart surgery mortality. BMJ 2007;335:759. (13 October.)[Abstract/Free Full Text]
2. Aylin P, Bottle A, Jarman B, Elliot P. Paediatric cardiac surgical mortality in England after Bristol: descriptive analysis of hospital episode statistics 1991-2002. BMJ 2004;329:825-9.[Abstract/Free Full Text]
3. Aylin P, Alves B, Cook A, Bennett J, Bottle A, Best N, et al. Analysis of hospital episode statistics for the Bristol Royal Infirmary inquiry. London: Division Primary Care and Population Health Sciences, Imperial College London, 1999. www.bristol-inquiry.org.uk/Documents/hes_(Aylin).pdf
4. Thames Valley Strategic Health Authority, Oxford Radcliffe Hospitals NHS Trust Paediatric Cardiac Surgery Steering Group. Report of the paediatric cardiac surgery steering group. TVSHA, 2005.
5. Keogh B. Surgery for congenital heart conditions in Oxford. BMJ 2005;330:319-20.[Free Full Text]

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