Performance, Data & Outcomes

In keeping with guidance from the NHS and Surgical Royal Colleges, the release of accurate outcome data after heart surgery is mandatory in the UK. The UK National Adult Cardiac Surgery Audit has completed a recent update for the period 1st April 2013 to 31st March 2016. The Southampton Cardiac Surgery team operates at Spire Southampton Hospital and University Hospital Southampton (UHS). The information contained in this report of Cardiac Surgery at Spire Hospital Southampton and UHS is in keeping with the most contemporary outcome data published for the UK by the Society for Cardiothoracic Surgery in the UK and Ireland (SCTS) on their website (www.scts.org).

UHS and Spire Southampton Hospital are two of only three units in the UK that have received positive outlier letters of congratulation from the SCTS for achieving survival rates higher than expected at or beyond the 95% confidence interval.

The data reported is for all adult patients, both NHS and private, having heart surgery during this three year period. However some operations, such as heart transplants and pericardiectomies, are excluded from the analysis. The full list of these exclusions is shown on www.scts.org. All emergencies (procedures that have to be done immediately such as ‘Type A’ dissections) are also excluded but ‘urgent’ procedures, where patients are in hospital prior to surgery, are included in the analysis.

Survival rates show the percentage of patients discharged alive from the hospital where they had their operation. Survival rates are ‘Risk Adjusted’ as some patients are more unwell and have more complex operations. To make fair comparisons between hospitals and surgeons, complex mathematical calculations are made to show what survival would have been had all patients been similar and all operations of ‘average’ difficulty. These calculations are based on an adaptation of the EuroSCORE model of risk adjustment and are fully explained on www.scst.org.

Case Mix

The first graph shown is the ‘Number and type of operations performed’ or Case Mix. Abbreviations include ‘Isolated’ when the procedure is carried out on its own, CABG (Coronary Artery Bypass Grafting), AVR (Aortic Valve Replacement), MVR (Mitral Valve Repair/Replacement) and complex ‘Other’ procedures, including double valve procedures, redo-operations and major thoracic aortic work. When exploring the SCTS website, patients can select a Health region of the United Kingdom on a map (South Central England Spire Southampton Hospital and UHS). The first drop down window for the Hospital of choice is for ‘number and type of operations performed’.

Graph 1 Shows the Case Mix for Spire Southampton as on the SCTS website.

Graph 2, extrapolated from the SCTS website, shows percentage of Spire Southampton Hospital cases 2013-2016 as a comparison to the rest of the United Kingdom for 2011-2014 (the latest 3 years for UK national data on procedure type). While stand-alone CABG accounts for over 50% of cases nationally, isolated CABG make up fewer than 35% of cases at Spire Southampton. This is the lowest number in the country and reflects that more than 65% of cases involve valve or more complex procedures. In particular, MVRs make up about 15% of cases at Spire, about twice the national average.

Graph 3 Shows the Case Mix for UHS as on the SCTS website

Graph 4 shows UHS 2013-2016 as a comparison to the rest of the United Kingdom for 2011-2014 (the latest 3 years for national data on procedure type). While stand-alone CABG accounts for over 50% of cases nationally, isolated CABG makes up fewer than 40% of cases at UHS. This is the lowest number of any NHS hospital in the UK and reflects that more than 60% of cases involve valve surgery or more complex procedures. In particular, ‘Other’ procedures, including redo-operations and major thoracic aortic work, make up more than 20% of cases at UHS, significantly more than the national average.

Risk Profile

Some patient risk factors such as age, gender and other medical problems can affect the outcome of heart surgery. The SCTS website shows comparisons between the individual units and the ‘national average’.

Graph 5 shows the risk profile for Spire Southampton Hospital as it appears on the SCTS website. Note that significantly more patients at Spire are over the age of 75 compared to the national average and Spire also has a greater than average female patient population.

Graph 6 shows the ‘average patient risk profile’ for UHS as it appears on the SCTS website. Note that more patients at UHS are over the age of 75 than the UK national average, there is a greater than average female patient population, almost twice as many ‘redo’ cardiac procedures than the national average, more patients with active endocarditis and significantly more patients undergoing surgery on the thoracic aorta.

Survival Rates

Funnel plots show survival rates achieved compared to the national average. Survival rates are expected to be closer to the average when more operations are performed. For this reason, ‘control limits’ are included to show the lowest and highest survival expected based on the number of operations and their difficulty. The lines shown on www.scts.org are statistically based on two ‘standard deviations’ from the average. Lower than expected outcomes could be due to inaccurate data quality or poor quality of care. Survival rates above the top control limit, as achieved by UHS and Spire Southampton, are better than expected and reflect a high quality service.

Graph 7 Shows the Risk-adjusted in hospital survival rate for Spire Southampton Hospital for April 2013 to March 2016 as it appears on the SCTS website with the national average survival shown by the horizontal blue line. These better than expected outcomes received congratulations from SCTS – one of only three of the forty UK units to achieve this and the only private hospital to do so.

Graph 8 shows the Risk-adjusted in hospital survival rate for UHS for April 2013 to March 2016 as it appears on the SCTS website with the national average survival shown by the horizontal blue line. These better than expected outcomes received congratulations from SCTS and NICOR - one of only three of the forty UK units to achieve this.

Graph 9 shows the risk adjusted survival for all UK units as on the SCTS website but with UHS and Spire Southampton Hospital highlighted. SCTS has chosen the scale of 0 to 100% to emphasize that, while there may be differences between units in survival rates, cardiac surgery is of a very high and consistent standard across the UK.

Graph 10, extrapolated from the www.scts.org website for all units in the UK, shows exactly the same data as Graph 9 above but on a scale of 90% to 100% with the national average survival of 98.04% demonstrated by the horizontal blue line.

Individual Surgeon Data

Reporting individual surgeon data is controversial with advantages, such as greater transparency and potential to learn from best practice, countered by disadvantages such as creation of league tables, potential for defensive practice and victimisation of individual surgeons. Moreover, the outcomes achieved by individual surgeons at Spire Hospital Southampton are a result of the corporate approach and teamwork of the Southampton CTS surgeons.

Despite the controversy, a recent update on individual surgeons for the period 1st April 2013 to 31st March 2016 has been published on the SCTS website (www.scts.org). Data for all surgeons performing adult cardiac surgery are shown with the same exclusions (emergencies, transplants, pericardiectomies etc.) in an attempt to avoid defensive practice. Individual surgeons in Southampton are all in the top ten in terms of number of cases performed by UK surgeons - including four of the top five. All surgeons have survival outcomes better than the UK average with ‘Case Mixes’ reflecting the surgeons’ individual sub-specialist interests – another component of the corporate approach of Southampton CTS surgeons.

The following graphs show these individual data, in alphabetical order, for the Southampton CTS surgeons.

The following graphs show data for Mr C.W. Barlow (as they appear on the SCTS website.)

Graph 14 shows Case Mix for Mr C.W. Barlow

Graph 15 shows Risk-adjusted in Hospital Survival rate for Mr C.W. Barlow for April 2013 to March 2016 as it appears on the SCTS website.

Graph 16 shows ‘average patient risk profile’ for Mr C.W. Barlow (GMC no. 3153444) as it appears on the SCTS website.

The following graphs show data for Mr S.A. Livesey (as they appear on the SCTS website.)

Graph 18 shows Case Mix for Mr S.A. Livesey

Graph 19 shows Risk-adjusted in Hospital Survival rate for Mr S.A. Livesey for April 2013 to March 2016 as it appears on the SCTS website.

Graph 20 shows ‘average patient risk profile’ for Mr S.A. Livesey (GMC no. 2490928) as it appears on the SCTS website.

Graph 21 shows risk adjusted survival for all surgeons as on the SCTS website with Mr S.A. Livesey highlighted. SCTS has chosen the scale of 0 to 100%.

The following graphs show data for Mr S.K. Ohri (as they appear on the SCTS website.)

Graph 22 shows Case Mix for Mr S.K. Ohri

Graph 23 shows Risk-adjusted in Hospital Survival rate for Mr S.K. Ohri for April 2013 to March 2016 as it appears on the SCTS website.

Graph 24 shows ‘average patient risk profile’ for Mr S.K. Ohri (GMC no. 3067473) as it appears on the SCTS website.

Graph 25 shows risk adjusted survival for all surgeons as on the SCTS website with Mr S.K. Ohri highlighted. SCTS has chosen the scale of 0 to 100%.

The following graphs show data for Mr G.M. Tsang (as they appear on the SCTS website.)

Graph 26 shows Case Mix for Mr G.M. Tsang

Graph 27 shows Risk-adjusted in Hospital Survival rate for Mr G.M. Tsang for April 2013 to March 2016 as it appears on the SCTS website.

Graph 28 shows ‘average patient risk profile’ for Mr G.M. Tsang (GMC no. 3198007) as it appears on the SCTS website.

Graph 29 shows risk adjusted survival for all surgeons as on the SCTS website with Mr G.M. Tsang highlighted. SCTS has chosen the scale of 0 to 100%.

The following graphs show data for Mr T. Velissaris (as they appear on the SCTS website.)

Graph 30 shows Case Mix for Mr T. Velissaris

Graph 31 shows Risk-adjusted in Hospital Survival rate for Mr T. Velissaris for April 2013 to March 2016 as it appears on the SCTS website.

Graph 32 shows ‘average patient risk profile’ for Mr T. Velissaris (GMC no. 4249887) as it appears on the SCTS website.

Graph 33 shows risk adjusted survival for all surgeons as on the SCTS website with Mr T. Velissaris highlighted. SCTS has chosen the scale of 0 to 100%.