people dying after major heart surgery under the NHS

Fewer people are dying after major heart surgery despite surgeons taking on more high-risk patients, an audit will confirm today.

But Britain’s top surgeon has criticised a £290 million funding gap between the money spent on encouraging innovation in the NHS and the funds for measuring the success of existing procedures.

Mortality rates for cardiac surgery have been measured since 2001 but remain the only type of procedure where the chances of survival are measured.

The chance of a person dying has fallen from 2.6 per cent in 2001 to 1.5 per cent last year, a report from the Society for Cardiothoracic Surgery found. The audit, covering more than 400,000 procedures across all hospitals in Britain, also found a marked fall in death rates among patients over the age of 75, from 5 per cent in 2004 to 3.4 per cent in 2008.

John Black, president of the Royal College of Surgeons, said that recording the data had produced real improvements for patients, despite more elderly people or those with complications being operated on.

While the NHS started publishing crude mortality rates for other selected operations last year, Mr Black criticised the lack of funding to develop this reporting.

“This comprehensive study shows that measuring results of surgery can help speed up improvements in quality of care.

“Surgeons in other disciplines would like to replicate what the cardiac surgeons have achieved but there remains a funding gap for these kinds of clinical audits,” he told The Times.

“At present around £8 million is available for this in the NHS, set against a £300 million NHS research budget into new treatments. Even a modest rebalance toward audit could speed up the uptake of new treatments and offer better value than focusing on innovation alone.”

Last year one in four of all patients undergoing coronary artery bypass surgery were older than 75. This is a rise of 10 per cent on the number in 1999. The proportion of patients with diabetes or high blood pressure also increased, as three quarters of patients having an isolated heart bypass were overweight and about a third were obese.

Doctors in other branches of surgery have previously been reluctant to publish mortality or other success rates for their procedures due to fears that “case-mix” could distort the figures.

A senior surgeon may have a lower score than a less-experienced colleague because he takes on a greater number of more difficult procedures, or has done more procedures overall, for example.

But Mr Black said that the figures for cardiac surgery proved that surgeons were not refusing to do more complicated work.

“All branches of surgery are following the trail on reporting outcomes that cardiac surgeons have blazed and this should spur those efforts on,” he added. “All of medicine should take note of the findings that full audit has not resulted in risk-averse behaviour.”

Mike Knapton, of the British Heart Foundation, welcomed the report but added that it highlighted variations in access to some types of operations in England. “Local healthcare providers need to investigate urgently why this is,” he added.

“If we are to tackle these inequalities and meet the needs of an increasingly elderly and obese population, we need a robust strategy to meet the future demand for cardiac surgery. The BHF is calling for a planned approach to cardiovascular provision in the coming decade.”

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