Death rates for children’s heart surgery have almost halved over past decade in England

Significantly more children are now surviving their first month after heart surgery, according to new research funded by Great Ormond Street Hospital’s Children’s Charity.

The analysis of national data, published in the online journal Open Heart, has revealed that deaths within 30 days of children’s cardiac surgery have almost halved in England over the past decade.

The findings have prompted researchers to suggest it is now time to shift the focus away from deaths within 30 days to longer term survival and other issues that matter greatly to patients and their families, such as measures of ill health and impact on children’s quality of life.

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.

In a bid to assess trends over time, researchers in this most recent study analysed data submitted to the National Institute of Cardiovascular Outcomes Research (NICOR) for all children under 16 between 2000 and 2010 inclusive.

The analysis included a total of 36,641 surgical procedures, corresponding to 30,041 individual patients, 5142 of whom underwent two or more procedures. In around one in 20 (4.4%) of these, the child had further surgery within 30 days.

The annual number of surgical procedures rose between 2000 and 2009 from 2283 to 3939, while the 30-day death rate fell consistently from 4.3% to 2.6% of cases, which compares favourably with similar data collected internationally.

This was despite an increase in the number and complexity of cases coming through for surgery.

Because the 30-day death rate is now so low, researchers at Great Ormond Street Hospital and other major cardiac centres in the UK are now shifting their focus to measuring children’s longer term survival, such as 90-day or 1-year survival rates.

GOSH’s lead clinician for cardiothoracic surgery, Mr Victor Tsang, who was involved in the latest study, said:

“This reduction in mortality rates for children’s heart surgery over the last decade in England is very encouraging, however it is important to remember that children’s heart surgery is intrinsically dangerous, particularly in complex cases.

“Great Ormond Street Hospital has the largest paediatric cardiac unit in the UK, and our 30-day mortality figure, based on the most current data, is 1.5%. This has been one of the most successful programmes in the UK.

“At GOSH we have already published data on our 90-day outcomes based on the arterial switch procedure as another way of monitoring performance, and are applying similar methodology to other congenital heart conditions. A portion of the funding for this project came from the same grant from GOSH Children’s Charity.

“We are also collaborating on a four-year project with four other paediatric cardiac programmes in the UK to evaluate the complications and quality of life in the first six months after children’s heart surgery, which is supported by a grant from the National Institute for Health Research.”