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Multicenter Study
. 2004 Oct 9;329(7470):825.
doi: 10.1136/bmj.329.7470.825.

Paediatric cardiac surgical mortality in England after Bristol: descriptive analysis of hospital episode statistics 1991-2002

Paul Aylin  1 , Alex Bottle, Brian Jarman, Paul Elliott
Affiliations
Multicenter Study

Paediatric cardiac surgical mortality in England after Bristol: descriptive analysis of hospital episode statistics 1991-2002

Paul Aylin et al. BMJ. .

Abstract

Objective: To describe trends in mortality of open cardiac surgery in children in Bristol and England since 1991.

Design: Retrospective analysis of hospital episode statistics data.

Setting: All open cardiac surgery of children in England.

Population: Patients younger than 16 undergoing open cardiac surgical procedures in England between April 1991 and March 2002. Three time periods were defined: epoch 3 (April 1991 to March 1995), epoch 5 (April 1996 to March 1999), epoch 6 (April 1999 to March 2002).

Main outcome measure: Mortality in hospital within 30 days of a cardiac procedure.

Results: We identified 5221 open operations between April 1996 and March 2002 in children under 1 year and 6385 in children aged 1-15 years. Mortality for all centres combined fell from 12% in epoch 3 to 4% in epoch 6. Mortality in children under 1 year at Bristol fell from 29% (95% confidence interval 21% to 37%) in epoch 3 to 3% (1% to 6%) in epoch 6, below the national average. The reduction in mortality did not seem to be due to fewer high risk procedures or an increase in the numbers of low risk cases. Oxford had a significantly higher mortality than the national average in all three epochs (11% (5% to 18%) in epoch 6), which was not affected by adjusting for procedure or the inclusion of cases with missing outcomes.

Conclusions: At Bristol, mortality for open operations in children aged under 1 year has fallen markedly, to below the national average. Nationwide mortality has also fallen. Improved quality of care may account for the drop in mortality, through new technologies or improved perioperative and postoperative care, or both.

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Figures

Fig 1
Fig 1
Mortality from open procedures in children aged under 1 year for 11 centres in three epochs; data derived from hospital episode statistics. Centres are listed by descending volumes of cases
Fig 2
Fig 2
Mortality (based on admissions with known outcome) for and number of open operations on children aged under 1 year from April 1991 to April 2002 in 11 English centres; data derived from hospital episode statistics
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References

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