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 medical and surgical treatment to children with congenital and acquired heart disease. 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 within a group of highly specialised services, namely extracorporeal life support (ECLS)heart and lung transplantationbridge to transplantationtracheal surgery and the treatment of pulmonary hypertension.

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 2014 to 2017, there were 1885 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 ‘much higher than predicted’.

Figure 1: Actual vs Predicted Survival Rates for all 13 centres in the UK and Republic of Ireland undertaking procedures in patients under 16 years of age 2014-2017 using PRAiS2 risk adjustment methodology.

Fig 1.1 Cardiothoracic actual vs predicted survival rates risk-adjusted 2014-17

Source: National Congenital Heart Disease Audit Annual Public Report 2014-17, page 4. 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 are also important to consider. The GOSH cardiothoracic team is committed to developing and using additional measures of outcomes in children with heart disease.

This information was published in January 2019.