Death rates for children’s heart surgery in the UK have almost halved in a decade, despite a rise in the number and complexity of cases, analysis shows.
Fatalities within 30 days of surgery fell from 4.3% of cases in 2000 to 2.6% of cases in 2009, at the same time as the annual number of episodes rose from 2,283 to 3,939, according to a paper published on Thursday in the online journal Open Heart.
Co-author Prof Martin Utley, from University College London’s clinical operational research unit, said: “The rates are low and have been falling – it’s encouraging news. I think there have been improvements in some of the standardisation of the care. There have been improvements in intensive care over that period as well.”
Higher than expected death rates at Bristol Royal Infirmary in the late 1980s and early 1990s, first revealed in 1995, led to a focus on child heart surgery.
Mandatory reporting of children’s heart surgery outcomes was introduced in 1997, and all specialist centres have submitted data to the UK Congenital Heart Audit since 2000, with figures for each individual centre published since 2004.
Researchers from four hospitals took part: Great Ormond Street, London; the Royal Hospital for Sick Children in Glasgow; Royal Brompton & Harefield NHS foundation trust, London; and Birmingham Children’s hospital.
They analysed data submitted to the National Institute of Cardiovascular Outcomes Research for all children under 16 between 2000 and 2010 inclusive, adjusting to reflect the different case mix. They found the results compared well with similar data from other international databases.
Utley said: “It does point towards a need for starting to focus on outcomes other than the short-term mortality and for attention to focus on longer-term mortality, 90-day or one-year mortality.”
The paper says more attention should also be given to functional outcomes, which may provide evidence on the comparative long-term benefits of different surgical strategies and models of care.
Utley said the increase in the number and complexity of cases did not necessarily mean congenital heart defects were increasing or becoming more problematic. For instance, although the number of cases defined as complex due to the weight of the patient being very low increased from 8.1% of the total to 10.4%, that might have been due to advances in keeping premature babies alive, he said.
Utley added: “It might be that surgical teams are taking on difficult cases, and cases that probably wouldn’t be taken on previously, as confidence increases in surgery.”
Prof Jeremy Pearson, associate medical director at the British Heart Foundation, said: “Surgery for children born with heart defects has dramatically improved in the UK over the last 50 years, from a position where very few babies survived to one where almost all do.
“This review of progress over the last 10 years is highly reassuring. Due to advances driven by research, surgeons are now able to perform more complex surgery, often on younger children with far more serious heart complications, than 10 years ago.”
“More effort now needs to be devoted to understanding the longer-term consequences of living with congenital heart disease after surgery, so we can further improve the quality of life for these patients.”