Mortality rates after surgery for congenital heart defects in children andsurgeons' performance

Background A public inquiry into surgery for paediatric congenital heart de fects in Bristol, UK, underscored the need for reliable data on overall mor tality rates, which would allow assessment of individual surgeons' performa nce. We aimed to gather and report such data for 1 year to provide informat ion for clinicians, researchers, policy makers, and the general public. Methods We collected data on all operations (1378) for congenital heart def ects done by 11 surgeons in five departments in the UK between April 1, 199 7, and March 31, 1998, These operations represented about 36% of all operat ions done in the UK during that time. Clearly defined criteria were agreed to classify operations into subgroups. Findings The overall mortality rate for all operations was 4.0% (95% CI 3.0 -5.2). No deaths occurred for 67 arterial-switch operations, Mortality rate s for coarctation, ventricular septal defect, atrioventricular septal defec t, Fallot, and truncus arteriosus operations were 1.1%, 0.6%, 3.6%, 2.3%, a nd 28.6%, respectively. Although overall mortality rates between surgeons v aried (1.6-6.9%), no surgeon's were higher than the 95% CI, The numbers of operations done by individual surgeons were small, which led to wide confid ence intervals and made the detection of differences in performance difficu lt. Interpretation The participating departments seemed to reach high standards of care for children with congenital heart defects, although more data wou ld be needed to assess performance of individual surgeons. The development of quality standards will be difficult because of the complexity of defects , the different types of operations, and few patients in each subgroup. Col lection of larger sets of data for more patients and centres are needed.