Cardiothoracic clinical outcomes
Clinical outcomes are measurable changes in health, function or quality of life that result from our care. Constant review of our clinical outcomes establishes standards against which to continuously improve all aspects of our practice.
About the cardiothoracic service
The cardiothoracic service at Great Ormond Street Hospital (GOSH) provides surgical treatment to children with congenital and acquired heart disease with the spectrum of heart problems, including complex neonatal repair. The cardiothoracic service sees children that are treated from birth until adolescence, when they are transferred to the Grown Up Congenital Heart Unit (GUCH). The team provides a tertiary referral service both nationally and internationally and performs the largest number of paediatric cardiothoracic operations in the United Kingdom. The cardiothoracic service also manage children requiring a group of highly specialised services, including extracorporeal life support (ECLS), bridge to transplantation, heart and lung transplantation, and tracheal surgery.
Clinical outcome measures
1. Risk adjusted 30-day survival for paediatric cardiac surgery (validated data: NICOR)
The 30-day survival rate for paediatric cardiac surgery is a nationally accepted benchmark that is used to judge outcomes. Predicted patient survival is determined for all centres using a calculation called PRAiS2, which adjusts for procedure, age, weight, diagnosis, and co-occurring conditions (co-morbidities).
The chart below shows that we perform the highest number of surgical episodes in the UK and Ireland. In the three years between 2018-2021, there were 1,582 cardiac operations performed in our unit, of which 99.2% of patients survived to 30 days. Based on the confidence limits selected by the National Congenital Heart Audit (NCHDA), our risk-adjusted survival rates for paediatric cardiac surgery are defined as ‘higher than predicted’.
Figure 1: Actual vs Predicted Survival Rates for all 11 centres in the UK and Republic of Ireland (excluding Scottish centres) undertaking cardiac procedures in patients under 16 years of age between 2018 and 2021 using the PRAiS2 risk adjustment methodology.
Source: National Congenital Heart Disease Audit (NCHDA) 2022 Summary Report (2020/21 Data), page 19. GOSH is the centre GOS.
Detail of outcomes for specific operations can be found at National Institute for Cardiovascular Outcomes Research Congenital Heart Disease website.
In 2016, a website called Understanding Children’s Heart Surgery Outcomes was launched to help parents and families to make sense of published survival data about children’s heart surgery in the UK and Ireland.
30-day survival is an important measure, but it is limited. Longer term survival and measures of health and wellbeing, such as quality of life and neurodevelopmental outcomes, are also important to consider. The GOSH cardiothoracic team is committed to developing and using additional outcome measures in children with heart disease.
This information was updated in July 2022.