ASCTS Report.

Australasian Society of Cardiothoracic Surgeons

(ASCTS)

Victorian Cardiac Surgery Database Project

Annual Report 2001-2002

Surgeons Report

Prepared by:

C.M. Reid, M. Rockell, P Skillington, G. Shardey on behalf of the ASCTS Database Project Steering Committee

ASCTS Surgeon’s Comprehensive report 2001-2002 Page 1 of 834/10/2023


2001 – 2002 First Annual Report For ASCTS Database

Mr. Peter SkillingtonPresident of Australasian Society of Cardiac and Thoracic

Surgeons

It is very pleasing to oversee the initial report, which covers the first year of data collection, for the ASCTS Database for Adult Cardiac Surgery. This is a comprehensive report for cardiac surgeons, which has been modeled on the Society of Cardiothoracic Surgeons of Great Britain and Ireland report. Many of you would have seen the initial public report for this time period of data collection (1/8/01 – 31/7/02), which was presented to the Victorian Government, to cover data collected for the six Victorian Public Hospitals which have participated in the database.

You will notice that there are three separate reports enclosed, as well as notes on the processes used. The three reports are as follows:

(a) Public Report – You have already seen this, it was delivered to the Victorian Department of Health in March, 2003.

(b) Comprehensive Surgeon’s Report – Detailed analysis of mortality and morbidity of CABG, valve, and other procedures, as well as analysis of results, depending on various pre-operative demographics and cardiac risk factors.

(c) In House Reporting Module – Each of the six Victorian Hospitals has the facility to print out a report of any particular period, according to this module. Thus, Victorian Units can compare their own results according to the module, with the overall results.

There is quite a bit of duplication present as a result of there being three reports, although it does provide a way for each Unit to quickly compare their own results with the overall cohort.

With the demise of the National Heart Foundation and AIHW Yearly Reports, we are proud to be able to present a comprehensive report on data collected, near contemporaneously. This report comes out approximately 15 months after the end of the data collection period. Our forthcoming Contract with the Victorian Government, will allow yearly reports to cover financial year periods (1st July – 30th June), and our contract states that these reports should be available within six months of the end of each collection period.

As yet, the ASCTS Database only operates in Victoria, although as many of you would be aware, much effort is proceeding to extend the database to other States as well as New Zealand. At the present time, the only risk modeling that has been performed is risk-adjusted mortality for isolated CABG, according to Euroscore. We hope to develop our own risk-adjustment model for isolated CABG, as well as other procedures, and complications, in due course.

I would like to thank all Members of ASCTS, who have worked to make this possible, both nationally with the development of the original dataset, definitions, ethical and peer review aspects, as well as to the individual Members of the Victorian Steering Committee. I would also like to thank the Victorian Department of Health Services for their ongoing support and funding of this endeavor, as well as Melbourne Information Management, and the Baker Heart Research Institute for the work that they have done on our behalf.


Foreword


Introduction to the Annual Report of the ASCTS Database 7

Public Report (2001-2002) 11

Comprehensive Surgeon’s Report (2001-2002) 31

Valve data 32

Isolated CABG data 46

Other group data 56

Factors contributing to morbidity in the whole population 57

In-house reporting module – report for all units combined 63

Processes 73

Data Management 74

Peer Review Mechanism 75

Data Collection Form 76

Patient Information Sheet 82

Opt-off procedure 83


Index


Development of the ASCTS DatabaseThe proposal for a National Cardiothoracic Database was initiated by the Australasian Society of Cardiac and Thoracic Surgeons in 1996.The intent was to establish a system which would:

1. Assess the nature and outcomes of Cardiac surgery in Australasia.2. Provide Government and other interested Agencies with accurate,

validated, contemporaneous, risk-stratified information on surgical outcomes.

3. Allow patients access to information which will enhance informed consent.

4. Ensure the highest continuing standards of Cardiac surgery in Australasia.

This naturally demanded the following essentials:1. A minimum Dataset.2. Establishment of specific Definitions for the Dataset.3. Inclusion of all patients in the Database.4. Validation of all data.5. Risk adjustment, or Stratification, of outcome data.6. Contemporaneous availability of information.

Australian Cardiac surgery has a long history of data accumulation, initially through the NHF and subsequently the AIHW. However, this information was limited to numbers of procedures and mortality. It did not and could not comply with the requirements of the ASCTS.

Therefore a meeting to establish a Cardiac Surgical Database was held at Epworth Hospital in late 1997. The Victorian Government then established a consultative review to assess existing Cardiac Surgery Unit data collection systems and the feasibility of constructing a common database. This review recommended that the ASCTS initiative proceed.

Importantly, the Victorian DHS provided financial support for the Database project to proceed in Victoria, on condition that its practical feasibility was demonstrated. Accordingly, in July 2000, an Indicative Report, analyzing retrospectively collected data from five Victorian Cardiac surgical Units, was published. The Report demonstrated that a central agency could collect and generate comparative performance information. Significantly, it also confirmed that such information, harvested from several sources, each with their own collection systems and definitions, inevitably produced inaccurate and unreliable data.

Consequently, the ASCTS established a National Database Steering Committee and four subcommittees:

1. Dataset and Definitions.2. Data Analysis.


Introduction to the Annual Report of the ASCTS Database

3. Privacy and Ethics.4. Peer Review and Quality Assurance.

The deliberations of these Committees were presented and discussed at a National Cardiac Surgery Database workshop convened in Melbourne, in August, 2000.

Further encouragement for the project was provided by the publishing of unadjusted ‘league tables’ in the United States and United Kingdom and by evidence from the UK of the deleterious consequences of the absence of a National surgical outcome review. Specifically, the Victorian Government commissioned a Health Services Policy Review Discussion Paper which was published in 1999. Recommendation 24 of the Review stated “that the Commonwealth and States collaborate to develop a set of risk-adjusted, comprehensive, consumer-focused and current clinical performance indicators”.

The Victorian Government grant facilitated the creation of a Business Plan, produced by Melbourne Information Services and the appointment of the Cardio-Vascular Research Unit of the Baker Heart Research Institute as project managers. The Project was coordinated by a Steering Committee consisting of representatives from the participating Units and overseen by the Board of Australasian Cardiac Surgical Research Institution Limited.

The First Annual Report of the ASCTS DatabaseThe Report presents the results of prospectively collected data from all six Victorian Public Hospital Cardiac Surgical Units, from August 2001 to December 2002 inclusive. The methodology of data acquisition was rigorous. Identical information, in terms of Dataset and Definitions, was obtained from all Units.

The Report demonstrates that the outcomes of Victorian Units are acceptable, with no significant overall performance differences between units.

The FutureInclusion of All Australasian Cardiac Surgery UnitsThe ASCTS Database Project is now a reality. Its feasibility is demonstrated by this pilot project, which happened to take place in Victoria. As an integral component of the Project, a Software Program for data recording and reporting was generated. This would facilitate the adoption of the Database by any Unit. The next task is to progressively include all Australasian Units, in both the Public and Private sectors. All Units have expressed keen interest. However, lack of funding is a major impediment. Initiatives to obtain financial support have been instigated.

ResourcesA National project of this nature is expensive. Continued and stable funding is essential for data managers and their training, computer systems, the maintenance of database software, data transmission, validation processes, analysis and reporting programs and for central database personnel. Demonstrably, these costs are eclipsed by the benefits of the Database in terms of improved patient outcomes.


Modification of the Dataset and DefinitionsA dataset such as this must evolve. The current dataset was based on the US Society of Thoracic Surgeons (STS) model. Its application during the initial phase of the program has demonstrated necessary modifications consistent with Australasian requirements and progress in surgical techniques. Therefore, a review of the dataset and definitions will proceed at the end of this year. Nonetheless, the broad thrust of the program will be consistent with the established STS, UK and ECSUR Databases, in order to allow comparison.

Risk Adjustment and Risk Prediction ModelsSuch models, based on a variety of statistical techniques, have been developed by the UK and particularly the US STS Database Programs. Each recognizes that only models based on local data can validly reflect variation in clinical presentation and therefore outcomes. The development of such models requires large numbers of patients. Such numbers can only be acquired in a timely fashion if all Units contribute to the Program.

AcknowledgmentsThis Report was made possible by the vision and dedication of the members of the several Committees of the ASCTS, by the continuing involvement of all participating surgeons and allied health professionals, by the expertise and attention to detail of data managers and by the consistently superb contribution of the members of the Central Data Registry.

Finally, the ASCTS is grateful to DHS Victoria for its financial support and for its close and understanding involvement with the Project.

Gilbert C. Shardey FRACSChairman, ASCTS Cardiac Surgery Database Steering Committee



Public Report

This concise Public Report on the quality of cardiac surgical care provides accurate

information on the risk associated with cardiac surgery. A similar report is provided

for distribution to each individual participating cardiac surgery unit by the Victorian

Department of Human Services.

The Public Report covers some of the demographic and clinical characteristics of

people receiving cardiac surgery including information on:

Demographic characteristics of patients undergoing surgery in Victorian

Cardiac Surgery Units including:

Age and Gender distribution

Risk Factors

Aspects of Cardiac History

Types of operations undertaken in Victorian Cardiac Surgery Units

Raw, unadjusted Mortality by type of operation for procedures performed in

Victoria, the USA and the UK

Clinical Urgency Status of patients undergoing Surgery in Victorian Cardiac

Surgery Units

Mortality by patient clinical urgency status

Mortality by patient age for isolated CABG

The following key performance indicators have been identified for monitoring as

part of the report to the Victorian Government:


Public Report

30 day all-cause risk-adjusted mortality following isolated CABG

Post-operative deep sternal infections following isolated CABG

Post-operative haemorrhage requiring return to theatre following isolated CABG

Length of ICU Stay following isolated CABG

Length of Intubation time following isolated CABG

All six Victorian Public Hospital Adult Cardiac Surgery Units have participated in

the program. They are The Austin and Repatriation Medical Centre, Geelong

Hospital, Monash Medical Centre – Clayton, Royal Melbourne Hospital, St

Vincent’s Hospital and The Alfred.

Demographic Characteristics

The majority (63%) of people receiving cardiac surgery services were aged 60 to

80 years (Figure 1). Females made up 30% of cardiac surgery patients. In terms

of risk factors, 18% of those having cardiac surgery were current smokers, 28%

had diabetes and 66% had high blood pressure requiring treatment. Other

characteristics of patients undergoing treatment at each of the hospitals are

indicated in Table 1.


Figure 1: Age distribution of all patients having Cardiac Surgery in Victorian Public Hospitals, 1 August 2001 to 31 July 2002


80 + yrs

7%

70-79 yrs

33%

< 40 yrs

4%

40-49 yrs

7%

50-59 yrs

20%

60-69 yrs

30%

Table 1: Characteristics of Patients undergoing Surgery in Victorian Cardiac Surgical Units: 2001 - 2002

HospitalCharacteristic

A B C D E F Total

Total number of Cases included 627 507 418 334 344 760 2990Cases included in this analysis* 621 502 417 334 341 759 2974

Age and Sex DistributionMean Age (yr) 65 66 63 64 67 65 65>80 yrs (%) 9 5 2 7 7 8 7Males (%) 72 71 70 72 67 70 70

DOSAElective Day of Surgery Admission (%) 52 10 48 12 5 64 38

Risk FactorsCurrent Smoker (%) 17 24 19 13 18 18 18Diabetes (%) 28 25 28 25 25 32 28Hypertension(%) 59 66 66 63 55 79 66Cerebrovascular disease (%) 8 10 9 14 12 12 11Peripheral Vascular Disease (%) 14 11 12 9 12 11 12

Cardiac HistoryPrevious Cardiac Intervention (%) 21 13 14 20 18 17 17

Previous CABG (%) 8 4 3 5 4 4 5Previous Valve (%) 3 1 1 3 2 1 2Previous PTCA / Stent (%) 9 8 8 12 11 8 9

Myocardial Infarction (%) 42 43 41 40 46 43 43- of which <21days (%) 35 36 32 29 37 26 32

Congestive Heart Failure (%) 32 31 16 23 28 33 28*16 Procedures were excluded where 1) the procedure was a second procedure for a patient on the same day (50%), 2) where data on 30-day mortality, type of procedure or urgency status were missing (44%) or 3) where the patient had opted-off the database (6%)


Types of Operations

Procedures that are performed in the cardiac surgery units include Coronary

Artery Bypass Graft Surgery (CABG) (68% of procedures), heart valve repair or

replacement (12%), a combination of both procedures (8%) with the remaining

12% of procedures being made up of all other less common cardiac procedures

or combinations of procedures.

Mortality by Type of Operation

The mortality rate for each of the three major groups of procedures is lower in

Victoria than that reported in published data from the USA and UK. The

mortality rate within thirty days of surgery for isolated CABG is around 2% (or

one death for every fifty patients). It should be noted that the “other” category,

which comprises only 12% of operations, includes a wide range of procedures,

many of which are associated with high risk. The overall mortality rate for this

mixed group of procedures is around 10% (Figure 2).


Figure 2: Mortality rate for cardiac surgery by procedure group, USA, UK and Victorian Public Hospitals, 1 August 2001 to 31 July 2002


Clinical Urgency Status for Isolated CABG and related mortality

Of the 2022 people undergoing isolated CABG between 1 August 2001 and 31

July 2002, 64% of people were admitted as elective patients, 30% of people

were operated upon as urgent cases, 5% of people were operated on as

emergency (that is within 24 hours of presentation) and <1% of people where

operated on as “salvage” procedures, that is where a life-threatening event had

already occurred (Figure 3).

The mortality rate for each of these patient groups is shown in Figure 4. The

mortality rate for people undergoing elective surgery is approximately one-tenth

the rate for emergency surgery.

Patient Age and Related Mortality

Older patients have less capacity to sustain cardiac surgery. This is reflected in

mortality rates for elective isolated CABG surgery with the increasing mortality

rate with increasing age shown in Figure 5. Despite this increase with age the

mortality rate for people 80 years and older peaks at 4% or approximately one

death per 25 people undergoing an operation.


Figure 3: Status of Patients undergoing Isolated CABG procedures, Victorian Public Hospitals, 1 August 2001 to 31 July 2002


Salvage 0.8%

Emergency 5.2%

Urgent 29.8%

Elective 64.2%

Figure 4: Mortality rate for isolated CABG surgery by clinical urgency status of the patient, Victorian Public Hospitals, 1 August 2001 to 31 July 2002


Figure 5: Mortality rate following elective isolated CABG surgery by Age Group, Victorian Public Hospitals, 1 August 2001 to 31 July 2002


Performance Indicators

Comparison of Mortality for isolated CABG by Surgical Unit

The comparison between mortality rates (within 30 days of isolated CABG) for

all Victorian Public Hospital Cardiac Surgery Units as well as UK and USA

benchmarks is shown in Figure 6. The average Victorian Cardiac Surgery

mortality rate is below the rate for both the UK and the USA. Two Victorian

Cardiac Surgery Units had a mortality rate above the USA benchmark and

three hospitals had a rate above the UK benchmark. All hospitals in Victoria fell

within 3 standard deviations of the mean and are therefore not significantly

different in 30 day mortality outcomes.


Figure 6: The Mortality rate within 30 days of isolated Coronary Artery Bypass Graft Surgery (CABG), Victorian Public Hospitals, 1 August 2001 to 31 July 2002. The average mortality rate for UK and USA hospitals are shown with the large and small dashed lines respectively.


Number of deaths: 4 4 4 7 3 4 0 2 2 8 3 2

Figure 7: The Mortality rate within 30 days of Coronary Artery Bypass Graft Surgery (CABG), elective vs non-elective procedures, Victorian Public Hospitals, 1 August 2001 to 31 July 2002. Numbers represent the actual numbers of deaths in each category


Post-operative Deep Sternal Infection and Haemorrhage

Deep sternal infection is a serious complication of CABG surgery. This

complication is rare (all units having an incidence of 1%), and hence is affected

by a small amount of random variation. Post-operative haemorrhage requiring

return to the operating theatre is not as serious a complication, but does impact on

theatre and blood bank utilisation. The deep sternal infection and return to theatre

for post-operative haemorrhage complication rates post CABG for each of the

Cardiac Surgery Units are shown in Figures 8 and 9 respectively. Although the

rates appear to differ between Cardiac Surgery Units, all Units have very low rates

and have performed well within the expected statistical limits. Whilst there is no

evidence of a statistical difference in these complication rates between Cardiac

Surgery Units, it is important to note that one hospital has reported no cases of

deep sternal infection over the 12 month period. This should be closely examined

further for strategies to improve the already low rates reported in other Units.

Length of Stay and Mechanical Ventilation

The length of stay in ICU and the period of time that a patient requires mechanical

ventilation (support to breathe) post-operatively are important cost measures of

cardiac surgical care. The need for mechanical ventilation is dependent on the

extent and complexity of the cardiac surgery being undertaken, the patient’s age

and the presence of obesity or pre-existing respiratory disease. The period of time

for which mechanical ventilation is required and the time spent in ICU are

interdependent, since mechanical ventilation is the most common reason

necessitating prolonged ICU care. Patients will usually require mechanical

ventilation after cardiac surgery. On occasions this will be for long periods of time

depending on the patient’s condition. The mean and median duration of time spent


in ICU and spent intubated (on mechanical ventilation) in each Cardiac Surgery

Unit are shown in figures 10 and 11 respectively. The median times (which vary

little between Units) are more accurate indicators of each Units performance, as

outliers with prolonged times can distort the mean values.

Number of cases: 2 1 2 2 0 2 9* * - total number

Figure 8: Deep sternal infection rate following isolated CABG, Victorian Public Hospitals, 1 August 2001 to 31 July 2002


Number of cases: 12 10 4 2 7 8 43*

* - total number

Figure 9: Rate of Post-operative haemorrhage requiring return to theatre following isolated CABG, Victorian Public Hospitals, 1 August 2001 to 31 July 2002


Figure 10: Average and Median length of ICU stay in hours post isolated CABG, Victorian Public Hospitals, 1 August 2001 to 31 July 2002


Figure 11: Average and Median length of Intubation time in hours post isolated CABG, Victorian Public Hospitals, 1 August 2001 to 31 July 2002


Summary

In this report, it can be seen that the outcomes from cardiac surgery in Victorian

Public Hospitals are as good or better than equivalent overseas results, and that

there are no significant differences in the performance outcomes between the

individual units.

It is expected that the introduction of this database will result in further

improvements in the quality and outcome of care in Victorian patients having

cardiac surgery operations in the Public Hospital system.



Comprehensive Surgeon’s Report

This Report provides a more comprehensive assessment of the data than the

Public Report. It gives the opportunity to look for emerging trends within the data,

and to drill down to look for inter-relationships between variables.

The Surgeon’s Report includes further data on the following:

Valve data

This section includes data on valve procedures, performed both with and without Coronary Artery Bypass Graft.

Data is presented on: Procedure typeProsthesis useMortalityPost-operative complicationsPost-operative indicators

Isolated CABG data

This section presents data for Isolated Coronary Artery Bypass Graft procedures.

Data is presented on: GraftsMortalityPost-operative complicationsPost-operative indicators

‘Other’ Group data

This section provides outcome data on operations other than valve and Coronary Artery Bypass Graft procedures, or where a combination of procedures not covered in the previous section were conducted in the same theatre episode.

Factors Contributing to Outcomes in the Whole Population

This section provides outcome data for all cardiac surgery procedures in relation to a number of risk factors.


Comprehensive Surgeon’s Report

Valve data

SINGLE VALVE OPERATIONSWITHOUT CABG WITH CABG

Initial Redo Total Total

No. Died % No. Died % No. Died % No. Died %

AorticAnnuloplasty only 0 - - 0 - - 0 - - 1 0 0.0

Replacement 189 5 2.6 11 1 9.1 200 6 3.0 176 9 5.1Root reconstruction with valve conduit

15 0 0.0 1 1 100.0 16 1 6.3 3 0 0.0

Resuspension 0 - - 1 1 100.0 1 1 100.0 0 - -Repair / Reconstruction with annuloplasty

0 - - 0 - - 0 - - 1 0 0.0

Repair / Reconstruction without annuloplasty

4 0 0.0 1 0 0.0 5 0 0.0 0 - -

Root reconstruction with valve sparing

2 0 0.0 0 - - 2 0 0.0 1 0 0.0

Resection sub aortic stenosis

1 0 0.0 0 - - 1 0 0.0 0 - -

Aortic total 211 5 2.4 14 3 21.4 225 8 3.6 182 9 4.9

MitralAnnuloplasty only 5 0 0.0 0 - - 5 0 0.0 6 0 0.0

Replacement 48 1 2.1 6 1 16.7 54 2 3.7 26 0 0.0Repair / Reconstruction with annuloplasty

37 0 0.0 0 - - 37 0 0.0 17 0 0.0

Repair / Reconstruction without annuloplasty

0 - - 1 0 0.0 1 0 0.0 0 - -

Mitral total 89 1 1.1 7 1 14.3 97 2 2.1 49 0 0.0

TricuspidReplacement 2 0 0.0 0 - - 2 0 0.0 0 - -Repair / Reconstruction with annuloplasty

1 0 0.0 0 - - 1 0 0.0 0 - -

Tricuspid total 3 0 0.0 0 - - 3 0 0.0 0 - -

PulmonaryReplacement 2 0 0.0 0 - - 2 0 0.0 0 - -

Pulmonary total 2 0 0.0 0 - - 2 0 0.0 0 - -

Total single valve 306 6 2.0 21 4 19.0 327 10 3.1 231 9 3.9

MULTIPLE VALVE OPERATIONS

Double valvesMitral & Aortic 18 1 5.6 1 1 100.0 19 2 10.5 3 0 0.0

Mitral & Tricuspid 4 1 25.0 2 1 50.0 6 2 33.3 2 0 0.0

Aortic & Tricuspid 2 0 0.0 0 - - 2 0 0.0 0 0 0.0

Other double valves 6 0 0.0 2 0 0.0 8 0 0.0 0 0 0.0

Double total 30 2 6.7 5 2 40.0 35 4 11.4 5 0 0.0

Triple total 3 0 0.0 1 0 0.0 4 0 0.0 0 - -

Total Multiple 33 2 6.1 6 2 33.3 39 4 10.3 5 0 0.0

Total single 306 6 2.0 21 4 19.0 327 10 3.1 231 9 3.9

Total valve 339 8 2.4 27 6 22.2 366 14 3.8 238 10 4.2


Valve data

VALVE BY PROSTHESIS TYPE

Single valve without CABG

Valve Position

Aortic Mitral Tricuspid Pulmonary

n 225 97 3 2

None 3.6% 2.1% 0.0% 0.0%

Mechanical 34.7% 47.4% 0.0% 0.0%

Bioprosthesis 56.4% 6.2% 66.7% 50.0%

Homograft / Allograft 4.5% 1.0% 0.0% 50.0%

Autograft 0.0% 0.0% 0.0% 0.0%

Ring/Annuloplasty 0.9% 43.3% 33.3% 0.0%

Single valve with CABG

Valve Position


n 182 49 0 0

None 0.5% 0.0% - -

Mechanical 25.3% 38.8% - -

Bioprosthesis 74.2% 12.2% - -

Homograft / Allograft 0.0% 2.0% - -

Autograft 0.0% 0.0% - -

Ring/Annuloplasty 0.0% 46.9% - -

Single valve with or without CABG

Valve Position


n 407 146 3 2

None 2.2% 1.4% 0.0% 0.0%

Mechanical 30.5% 44.5% 0.0% 0.0%

Bioprosthesis 64.4% 8.2% 66.7% 50.0%

Homograft / Allograft 1.0% 1.4% 0.0% 50.0%

Autograft 1.5% 0.0% 0.0% 0.0%

Ring/Annuloplasty 0.5% 44.5% 33.3% 0.0%


Valve data

VALVE BY AETIOLOGY AND AGE

All Aortic valve procedures

Age Group<40

years40-49

yrs50-59

yrs60-69

yrs70-79

yrs80+ yrs

Total

n 25 31 60 133 197 81 527

Rheumatic 4.0% 9.7% 10.0% 11.3% 6.6% 3.7% 7.8%

Congenital 36.0% 25.8% 25.0% 21.1% 9.1% 4.9% 15.6%

Ischaemic 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0%

Idiopathic Calcific 0.0% 19.4% 31.7% 42.9% 60.9% 71.6% 49.3%

Myxomatous degeneration 4.0% 6.5% 3.3% 9.8% 9.1% 12.3% 8.7%

Failed prior repair 0.0% 3.2% 0.0% 0.0% 0.0% 0.0% 0.2%

Prosthetic valve failure 4.0% 0.0% 0.0% 0.0% 1.5% 1.2% 0.9%

Peri-prosthetic leak 0.0% 0.0% 1.7% 0.0% 0.5% 0.0% 0.4%

Prosthetic valve thrombosis 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0%

Active infection 20.0% 9.7% 11.7% 3.0% 3.6% 1.2% 5.1%

Previous infection 8.0% 0.0% 0.0% 1.5% 0.0% 0.0% 0.8%

Marfans 8.0% 3.2% 0.0% 0.8% 0.0% 0.0% 0.8%

Annuloaortic ectasia 0.0% 0.0% 6.7% 3.8% 2.5% 2.5% 3.0%

Other degenerative disease 4.0% 6.5% 0.0% 0.8% 1.5% 0.0% 1.3%

Dissection 4.0% 12.9% 8.3% 4.5% 0.5% 0.0% 3.2%

Tumour 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0%

Trauma 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0%

Iatrogenic 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0%

Other 4.0% 0.0% 1.7% 0.8% 2.5% 1.2% 1.8%

Not specified 4.0% 3.2% 0.0% 0.0% 1.5% 1.2% 1.1%


Valve data

VALVE BY AETIOLOGY AND AGE

All Mitral valve procedures

Age Group<40

years40-49

yrs50-59

yrs60-69

yrs70-79

yrs80+ yrs

Total

n 18 14 31 73 73 11 220

Rheumatic 5.6% 42.9% 35.5% 28.8% 17.8% 9.1% 24.1%

Congenital 11.1% 0.0% 3.2% 0.0% 1.4% 0.0% 1.8%

Ischaemic 0.0% 0.0% 3.2% 9.6% 19.2% 0.0% 10.0%

Idiopathic Calcific 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0%

Myxomatous degeneration 16.7% 35.7% 29.0% 47.9% 46.6% 54.5% 41.8%

Failed prior repair 11.1% 7.1% 3.2% 0.0% 2.7% 0.0% 2.7%

Prosthetic valve failure 0.0% 0.0% 0.0% 0.0% 1.4% 0.0% 0.5%

Peri-prosthetic leak 5.6% 0.0% 3.2% 1.4% 1.4% 9.1% 2.3%

Prosthetic valve thrombosis 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0%

Active infection 33.3% 7.1% 9.7% 1.4% 2.7% 9.1% 6.4%

Previous infection 5.6% 0.0% 3.2% 1.4% 0.0% 0.0% 1.4%

Marfans 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0%

Other degenerative disease 0.0% 0.0% 0.0% 1.4% 1.4% 0.0% 0.9%

Dissection 0.0% 0.0% 0.0% 1.4% 0.0% 0.0% 0.5%

Tumour 5.6% 0.0% 0.0% 0.0% 0.0% 0.0% 0.5%

Trauma 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0%

Iatrogenic 0.0% 0.0% 0.0% 0.0% 1.4% 0.0% 0.5%

Other 5.6% 0.0% 9.7% 5.5% 1.4% 9.1% 4.5%

Not specified 0.0% 7.1% 0.0% 1.4% 2.7% 9.1% 2.3%


Valve data

Mortality

SUMMARY

Number of Operations

30 day Mortality (n)

30 day Mortality (%)

Valves only

Aortic Valve Surgery only 225 8 3.6%

Aortic Valve Replacement only 200 6 3.0%

Mitral Valve Surgery only 99 2 2.0%

Mitral Valve Replacement only 54 2 3.6%

MV Repair only 38 0 0.0%

Tricuspid Valve Surgery only 3 0 0.0%

Pulmonary Valve Surgery only 2 0 0.0%

Aortic & Mitral Valve Surgery only 19 2 10.5%

Mitral & Tricuspid Valve Surgery only 6 2 33.3%

Aortic & Tricuspid Valve Surgery only 2 0 0.0%

Other Doubles 8 0 0.0%

Triples 4 0 0.0%

Valves & CABG only

Aortic Valve Surgery & CABG only 182 9 4.9%

Aortic Valve Replacement & CABG only 176 9 5.1%

Mitral Valve Surgery & CABG only 49 0 0.0%

Mitral Valve Replacement & CABG only 26 0 0.0%

Mitral Valve Repair & CABG only 17 0 0.0%

Aortic & Mitral Valve Surgery & CABG only 3 0 0.0%

Mitral & Tricuspid Valve Surgery & CABG only 2 0 0.0%

TOTAL Valve (with or without CABG) only

604 24 4.0%


Valve data

SINGLE VALVE – INITIAL OPERATION ONLYMortality

BY CARDIAC SURGERY UNIT


Valve data

Mortality

BY AGE

Single valve with or without CABG

30 day Mortality (mortality/n %)

Age Group

<40 years 40-49 yrs 50-59 yrs 60-69 yrs 70-79 yrs 80+ yrs

Aortic 1/12 8.3% 0/16 0.0% 0/40 0.0% 3/99 3.0% 6/172 3.5% 7/68 10.3%

Mitral 0/6 0.0% 0/7 0.0% 0/22 0.0% 0/50 0.0% 2/53 3.8% 0/8 0.0%

Tricuspid 0/1 0.0% 0/1 0.0% 0/0 - 0/1 0.0% 0/0 - 0/0 -

Pulmonary 0/2 0.0% 0/0 - 0/0 - 0/0 - 0/0 - 0/0 -

Total 1/21 4.8% 0/24 0.0% 0/62 0.0% 3/150 2.0% 8/225 3.6% 7/76 9.2%

AVR + CABG only


Age Group


0/0 - 0/2 0.0% 0/8 0.0% 3/41 6.8% 1/91 1.1% 5/32 15.2%

BY CLINICAL STATUS

AVR + CABG only30 day Mortality (mortality/n %)

Operative Status

Elective Urgent Emergency Salvage

6/136 4.4% 3/36 8.3% 0/1 0.0% 0/1 0.0%

AVR + CABG only30 day Mortality (mortality/n %)

Redo Pre-op creatinine

Yes No <=0.2 >0.2

1/15 6.7% 8/159 5.0% 7/164 4.3% 2/10 20.0%


Valve data

Morbidity

BY VALVE POSITION

Single valve – Valve only

Post-operative complications

Valve Position

Aortic MitralTricuspid or Pulmonary Total

n 225 97 5 327

New Renal Failure 5.3% 2.1% 0.0% 4.3%

Cerebrovascular complication 3.1% 1.0% 0.0% 2.4%

Permanent Stroke 2.2% 1.0% 0.0% 1.8%

Transient Stroke 0.4% 0.0% 0.0% 0.3%

Continuous Coma 0.4% 0.0% 0.0% 0.3%

Deep Sternal Infection 0.0% 0.0% 0.0% 0.0%

Septicaemia 0.9% 1.0% 0.0% 0.9%

Return to theatre (all cause) 9.8% 7.2% 0.0% 8.9%

Re-op for Bleeding 6.7% 5.2% 0.0% 6.1%

Peri-operative AMI 0.4% 0.0% 0.0% 0.3%

New Cardiac Arrhythmia 36.9% 34.0% 0.0% 35.5%

Pneumonia 5.3% 5.2% 0.0% 5.2%

GIT complication 1.8% 1.0% 0.0% 1.5%

Multi-system Failure 0.9% 1.0% 0.0% 0.9%

Anticoagulant complication 0.4% 1.0% 0.0% 0.6%

Red Blood Cells transfused 47.6% 38.1% 40.0% 44.6%

Non-RBC blood products 28.9% 22.7% 0.0% 26.6%

Post-operative indicators Intubation Time <=10hrs 57.9% 70.8% 80.0% 62.1%

10-20hrs 30.3% 24.0% 20.0% 28.3%

>20hrs 11.8% 5.2% 0.0% 9.6%

Post-op Length of Stay

<= 5 days 19.1% 15.5% 0.0% 17.7%

5-10 days 59.6% 59.8% 80.0% 59.9%

>10 days 21.3% 24.7% 20.0% 22.3%

Intensive Care Stay

<=24hrs 54.3% 59.8% 40.0% 55.7%

>24hrs –4 days

38.1% 35.1% 60.0% 37.5%

> 4 days 7.6% 5.2% 0.0% 6.8%


Valve data

Morbidity

BY VALVE POSITION

Single valve – Valve with CABG only


Valve Position


n 182 49 0 231

New Renal Failure 12.1% 8.2% - 11.3%

Cerebrovascular complication 3.3% 8.2% - 4.3%

Permanent Stroke 1.1% 6.1% - 2.2%

Transient Stroke 2.2% 0.0% - 1.7%

Continuous Coma 0.0% 2.0% - 0.4%

Deep Sternal Infection 0.5% 2.0% - 0.9%

Septicaemia 2.7% 4.1% - 3.0%

Return to theatre (all cause) 5.5% 10.2% - 6.5%

Re-op for Bleeding 3.8% 8.2% - 4.8%

Peri-operative AMI 2.2% 0.0% - 1.7%

New Cardiac Arrhythmia 42.9% 44.9% - 43.3%

Pneumonia 7.7% 14.3% - 9.1%

GIT complication 3.8% 2.0% - 3.5%

Multi-system Failure 3.3% 2.0% - 3.0%

Anticoagulant complication 2.2% 2.0% - 2.2%

Red Blood Cells transfused 66.5% 65.3% - 66.2%

Non-RBC blood products 45.6% 36.7% - 43.7%

Post-operative indicators Intubation Time <=10hrs 47.8% 34.7% - 45.0%

10-20hrs 34.6% 26.5% - 32.9%

>20hrs 17.6% 38.8% - 22.1%


<= 5 days 8.8% 10.2% - 9.1%

5-10 days 53.3% 44.9% - 51.5%

>10 days 37.9% 44.9% - 39.4%

Intensive Care Stay

<=24hrs 36.3% 28.6% - 34.6%

>24hrs –4 days

48.9% 49.0% - 48.9%

> 4 days 14.8% 22.4% - 16.5%


Valve data

Morbidity

BY VALVE POSITION

Single valve – Valve with or without CABG only


Valve Position


n 407 146 5 558

New Renal Failure 9.8% 4.1% 0.0% 7.2%

Cerebrovascular complication 3.2% 3.4% 0.0% 3.2%

Permanent Stroke 1.7% 2.7% 0.0% 2.0%

Transient Stroke 1.2% 0.0% 0.0% 0.9%

Continuous Coma 0.2% 0.7% 0.0% 0.3%

Deep Sternal Infection 0.2% 0.7% 0.0% 0.3%

Septicaemia 1.7% 2.1% 0.0% 1.8%

Return to theatre (all cause) 7.9% 11.0% 0.0% 7.9%

Re-op for Bleeding 5.4% 6.2% 0.0% 5.6%

Peri-operative AMI 1.2% 0.0% 0.0% 0.9%

New Cardiac Arrhythmia 39.6% 37.7% 0.0% 38.7%

Pneumonia 6.4% 8.2% 0.0% 6.8%

GIT complication 2.7% 1.4% 0.0% 2.3%

Multi-system Failure 2.0% 1.4% 0.0% 1.8%

Anticoagulant complication 1.2% 1.4% 0.0% 1.3%

Red Blood Cells transfused 56.0% 47.3% 40.0% 53.6%

Non-RBC blood products 36.4% 27.4% 0.0% 33.7%

Post-operative indicators Intubation Time <=10hrs 52.8% 58.2% 80.0% 54.5%

10-20hrs 31.9% 26.7% 20.0% 29.9%

>20hrs 14.3% 16.4% 0.0% 14.7%


<= 5 days 14.5% 13.7% 0.0% 14.2%

5-10 days 56.8% 54.8% 80.0% 56.5%

>10 days 28.7% 31.5% 20.0% 29.4%

Intensive Care Stay

<=24hrs 45.9% 49.3% 40.0% 46.8%

>24hrs –4 days

42.8% 39.7% 60.0% 42.1%

> 4 days 10.8% 11.0% 0.0% 10.8%


Valve data

Morbidity

BY VALVE POSITION AND CARDIAC SURGERY UNIT



No. cases

Aortic

A 49B 45C 33D 23E 25F 50

Total 225

Mitral

A 15B 24C 13D 8E 12F 25

Total 97

Valve data

Morbidity

BY AGE



Age Group<40

years40-49

yrs50-59

yrs60-69

yrs70-79

yrs80+ yrs

Total

n 21 22 47 87 109 41 327

New Renal Failure 0.0% 0.0% 0.0% 1.1% 7.3% 12.2% 4.3%

Cerebrovascular complication 0.0% 4.5% 0.0% 2.3% 3.7% 2.4% 2.4%

Permanent Stroke 0.0% 4.5% 0.0% 1.1% 2.8% 2.4% 1.8%

Transient Stroke 0.0% 0.0% 0.0% 1.1% 0.0% 0.0% 0.3%

Continuous Coma 0.0% 0.0% 0.0% 0.0% 0.9% 0.0% 0.3%

Deep Sternal Infection 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0%

Septicaemia 4.8% 0.0% 0.0% 0.0% 0.9% 2.4% 0.9%

Return to theatre (all cause) 23.8% 9.1% 6.4% 9.2% 8.3% 4.9% 8.9%

Re-op for Bleeding 14.3% 0.0% 6.4% 6.9% 6.4% 2.4% 6.1%

Peri-operative AMI 0.0% 0.0% 0.0% 0.0% 0.9% 0.0% 0.3%

New Cardiac Arrhythmia 19.0% 27.3% 27.7% 39.1% 37.6% 43.9% 35.5%

Pneumonia 9.5% 0.0% 6.4% 1.1% 6.4% 9.8% 5.2%

GIT complication 4.8% 0.0% 2.1% 0.0% 2.8% 0.0% 1.5%

Multi-system Failure 0.0% 4.5% 0.0% 0.0% 1.8% 0.0% 0.9%

Anticoagulant complication 0.0% 0.0% 0.0% 1.1% 0.9% 0.0% 0.6%

Red Blood Cells transfused 52.4% 36.4% 34.0% 29.9% 54.1% 63.4% 44.6%

Non-RBC blood products 33.3% 31.8% 21.3% 24.1% 27.5% 29.3% 26.6%

Post-operative indicators

Intubation Time <=10hrs 65.0% 76.2% 61.7% 76.7% 52.3% 48.8% 62.1%

10-20hrs 25.0% 9.5% 34.0% 18.6% 34.6% 36.6% 28.3%

>20hrs 10.0% 14.3% 4.3% 4.7% 13.1% 14.6% 9.6%


<= 5 days 19.0% 22.7% 23.4% 24.1% 14.7% 2.4% 17.7%

5-10 days 33.3% 54.5% 55.3% 58.6% 63.3% 75.6% 59.9%

>10 days 47.6% 22.7% 21.3% 17.2% 22.0% 22.0% 22.3%

Intensive Care Stay

<=24hrs 52.4% 45.5% 63.8% 64.4% 55.1% 36.6% 55.7%

>24hrs –4 days

38.1% 40.9% 34.0% 32.2% 36.4% 53.7% 37.5%

> 4 days 9.5% 13.6% 2.1% 3.4% 8.4% 9.8% 6.8%


Valve data

Morbidity

BY AGE

Single valve – Valve with CABG only


Age Group<40

years40-49

yrs50-59

yrs60-69

yrs70-79

yrs80+ yrs

Total

n 0 2 15 63 116 35 231

New Renal Failure - 0.0% 6.7% 12.7% 6.9% 25.7% 11.3%

Cerebrovascular complication - 0.0% 0.0% 3.2% 4.3% 8.6% 4.3%

Permanent Stroke - 0.0% 0.0% 3.2% 1.7% 2.9% 2.2%

Transient Stroke - 0.0% 0.0% 0.0% 1.7% 5.7% 1.7%

Continuous Coma - 0.0% 0.0% 0.0% 0.9% 0.0% 0.4%

Deep Sternal Infection - 0.0% 0.0% 1.6% 0.9% 0.0% 0.9%

Septicaemia - 0.0% 6.7% 1.6% 1.7% 8.6% 3.0%

Return to theatre (all cause) - 0.0% 0.0% 9.5% 5.2% 8.6% 6.5%

Re-op for Bleeding - 0.0% 0.0% 9.5% 2.6% 5.7% 4.8%

Peri-operative AMI - 0.0% 0.0% 1.6% 1.7% 2.9% 1.7%

New Cardiac Arrhythmia - 50.0% 26.7% 42.9% 42.2% 54.3% 43.3%

Pneumonia - 0.0% 6.7% 6.3% 8.6% 17.1% 9.1%

GIT complication - 0.0% 0.0% 3.2% 3.4% 5.7% 3.5%

Multi-system Failure - 0.0% 6.7% 0.0% 2.6% 8.6% 3.0%

Anticoagulant complication - 0.0% 0.0% 3.2% 0.9% 5.7% 2.2%

Red Blood Cells transfused - 50.0% 40.0% 61.9% 68.1% 80.0% 66.2%

Non-RBC blood products - 50.0% 13.3% 44.4% 44.8% 51.4% 43.7%


Intubation Time <=10hrs - 50.0% 46.7% 47.6% 44.0% 42.9% 45.0%

10-20hrs - 50.0% 26.7% 31.7% 36.2% 25.7% 32.9%

>20hrs - 0.0% 26.7% 20.6% 19.8% 31.4% 22.1%


<= 5 days - 0.0% 26.7% 14.3% 5.2% 5.7% 9.1%

5-10 days - 50.0% 40.0% 47.6% 55.2% 51.4% 51.5%

>10 days - 50.0% 33.3% 38.1% 39.7% 42.9% 39.4%

Intensive Care Stay

<=24hrs - 0.0% 60.0% 38.1% 37.1% 11.4% 34.6%

>24hrs –4 days

- 100.0% 20.0% 47.6% 47.4% 65.7% 48.9%

> 4 days - 0.0% 20.0% 14.3% 15.5% 22.9% 16.5%


Valve data

Morbidity

BY AGE

Multiple valve – Valves onlyPost-operative complications

Age Group<40

years40-49

yrs50-59

yrs60-69

yrs70-79

yrs80+ yrs

Total

n 11 4 9 11 4 0 39

New Renal Failure 9.1% 0.0% 0.0% 0.0% 0.0% - 2.6%

Cerebrovascular complication 0.0% 0.0% 0.0% 9.1% 0.0% - 2.6%

Permanent Stroke 0.0% 0.0% 0.0% 0.0% 0.0% - 0.0%

Transient Stroke 0.0% 0.0% 0.0% 0.0% 0.0% - 0.0%

Continuous Coma 0.0% 0.0% 0.0% 9.1% 0.0% - 2.6%

Deep Sternal Infection 0.0% 0.0% 0.0% 0.0% 0.0% - 0.0%

Septicaemia 18.2% 0.0% 0.0% 0.0% 0.0% - 5.1%

Return to theatre (all cause) 9.1% 0.0% 11.1% 0.0% 0.0% - 5.1%

Re-op for Bleeding 0.0% 0.0% 11.1% 0.0% 0.0% - 2.6%

Peri-operative AMI 0.0% 0.0% 0.0% 0.0% 0.0% - 0.0%

New Cardiac Arrhythmia 27.3% 50.0% 11.1% 27.3% 75.0% - 30.8%

Pneumonia 9.1% 0.0% 0.0% 9.1% 0.0% - 5.1%

GIT complication 9.1% 0.0% 11.1% 0.0% 0.0% - 5.1%

Multi-system Failure 18.2% 0.0% 0.0% 9.1% 0.0% - 7.7%

Anticoagulant complication 0.0% 0.0% 0.0% 0.0% 0.0% - 0.0%

Red Blood Cells transfused 36.4% 25.0% 22.2% 36.4% 50.0% - 33.3%

Non-RBC blood products 54.5% 25.0% 44.4% 45.5% 25.0% - 43.6%


Intubation Time <=10hrs 72.7% 75.0% 44.4% 54.5% 0.0% - 53.8%

10-20hrs 9.1% 25.0% 55.6% 27.3% 100.0% - 35.9%

>20hrs 18.2% 0.0% 0.0% 18.2% 0.0% - 10.3%


<= 5 days 9.1% 25.0% 11.1% 18.2% 0.0% - 12.8%

5-10 days 72.7% 75.0% 66.7% 63.6% 50.0% - 66.7%

>10 days 18.2% 0.0% 22.2% 18.2% 50.0% - 20.5%

Intensive Care Stay

<=24hrs 27.3% 25.0% 22.2% 54.5% 0.0% - 30.8%

>24hrs –4 days

63.6% 75.0% 66.7% 27.3% 75.0% - 56.4%

> 4 days 9.1% 0.0% 11.1% 18.2% 25.0% - 12.8%


Isolated CABG data


Number of ProceduresTotal Number of procedures Redo Surgery

NumberMortality

(30 days post op)Number

Mortality(30 days post op)

Procedure type

Number of procedures

% of Isolated CABG

Number% of

Procedure type


% of Redo

Number

% of Procedure

type (redo)

Isolated CABG On Pump

1738 86.0% 43 2.5% 92 94.8% 4 4.3%

Isolated CABG Off Pump

284 14.0% 2 0.7% 5 5.2% 0 0.0%

TOTAL 2022 100.0% 45 2.2% 97 100.0% 4 4.1%

Number of distal anastomoses

Procedure type

Total number of procedures

X 1 X 2 X 3 X 4 X 5 X 6 X 7Mean

no. grafts


1738 34 283 734 534 132 17 4 3.3


284 62 115 69 25 8 3 2 2.4

TOTAL 2022 96 389 803 559 140 20 6 3.2

Arterial grafts

Procedure type


All arterial T or Y graftsNumber of procedures

% of procedure type


% of procedure type


1738 997 57.4% 183 10.5%


284 275 96.8% 124 43.7%

TOTAL 2022 1272 62.9% 307 15.2%

Conduits used

Procedure type


Number of IMA conduits (mutually exclusive)

Number of RAD (mutually exclusive)

Number of GEPA

procedures

Number of SVG

proceduresLIMA RIMA BIMA RAD x 1 RAD x 2Isolated CABG On Pump

1738 1340 23 277 903 435 1 741


284 249 5 25 163 7 0 9

TOTAL 2022 1589 28 302 1066 442 1 750


Isolated CABG data

Patient characteristics



No. cases

A 405B 347C 307D 195E 250F 518

Total 2022

Isolated CABG data




No. cases

A 405B 347C 307D 195E 250F 518

Total 2022

Isolated CABG data




No. cases

A 405B 347C 307D 195E 250F 518

Total 2022

Isolated CABG data

Mortality

BY AGE


Age Group


0/14 0.0% 1/143 0.7% 5/454 1.1% 11/636 1.7% 22/675 3.3% 6/100 6.0%

BY OPERATIVE STATUS


Operative Status

Elective Urgent Emergency Salvage

16/1267 1.3% 19/675 2.8% 9/73 12.3% 1/7 14.3%

BY PRE-OPERATIVE AMI

30 day Mortality (mortality/n %)Pre-op AMI Time since AMI

Yes No <6hrs 6-24hrs 1-7days 7-21days >21days

34/1051 3.2% 11/970 1.1% 3/17 17.6% 1/12 8.3% 9/149 6.0% 7/166 4.2% 14/706 2.0%

BY LV FUNCTION

30 day Mortality (mortality/n %)LV Dysfunction

Normal Mild Moderate Severe

7/747 0.9% 7/652 1.1% 12/362 3.3% 19/246 7.7%

MISCELLANEOUS


Gender Redo Off-pump

Male Female 1st proc Redo Off-pump On-pump

33/1514 2.2% 12/508 2.4% 41/1925 2.1% 4/97 4.1% 2/284 0.7% 43/1738 2.5%


Smoking Status Diabetes Pre-op creatinine

Current Non or Ex Yes No <=0.2mmol/L >0.2mmol/L

9/281 3.2% 36/1741 2.1% 13/652 2.0% 32/1370 2.3% 39/1968 2.0% 6/52 11.5%


Isolated CABG data

Morbidity

BY AGE


Age Group<40

years40-49 yrs 50-59 yrs 60-69 yrs 70-79 yrs 80+ yrs Total

n 14 143 454 636 675 100 2022





Continuous Coma 0.0% 0.0% 0.0% 0.2% 0.3% 2.0% 0.2%


Septicaemia 0.0% 0.0% 0.7% 2.0% 1.0% 3.0% 1.3%

Return to theatre (all cause) 0.0% 3.5% 2.4% 5.5% 4.6% 6.0% 4.4%


Peri-operative AMI 0.0% 0.7% 0.7% 0.9% 0.6% 4.0% 0.9%

New Cardiac Arrhythmia 7.1% 13.3% 18.7% 28.7% 38.7% 49.0% 29.5%

Pneumonia 0.0% 4.2% 4.2% 3.6% 5.2% 6.0% 4.4%

GIT complication 0.0% 0.0% 1.3% 1.1% 3.1% 7.0% 2.0%

Multi-system Failure 0.0% 0.0% 0.4% 0.8% 0.6% 2.0% 0.6%

Anticoagulant complication 0.0% 1.4% 0.0% 0.5% 0.9% 0.0% 0.5%

Red Blood Cells transfused 14.3% 19.6% 22.2% 36.9% 46.5% 64.0% 36.8%

Non-RBC blood products 0.0% 16.1% 10.4% 21.4% 21.0% 24.0% 18.4%



10-20hrs 23.1% 16.5% 20.4% 25.4% 27.6% 29.6% 24.6%

>20hrs 7.7% 4.3% 6.2% 7.9% 11.1% 14.3% 8.7%


<= 5 days 78.6% 49.0% 48.5% 31.6% 20.7% 15.0% 32.5%

5-10 days 21.4% 48.3% 46.3% 57.7% 63.9% 56.0% 56.2%

>10 days 0.0% 2.8% 5.3% 10.7% 15.4% 29.0% 11.3%

Intensive Care Stay

<=24hrs 85.7% 69.2% 67.6% 60.7% 57.5% 45.9% 61.3%

>24hrs –4 days

14.3% 28.7% 29.3% 34.2% 36.8% 40.8% 33.8%

> 4 days 0.0% 2.1% 3.1% 5.1% 5.6% 13.3% 5.0%


Isolated CABG data

Morbidity

BY OPERATIVE STATUS


Operative Status

Elective Urgent Emergency Salvage Total

n 1267 675 73 7 2022

New Renal Failure 3.4% 3.3% 6.8% 14.3% 3.5%

Cerebrovascular complication 1.0% 1.0% 4.1% 0.0% 1.1%

Permanent Stroke 0.6% 0.4% 2.7% 0.0% 0.6%

Transient Stroke 0.4% 0.4% 1.4% 0.0% 0.4%

Continuous Coma 0.2% 0.1% 1.4% 0.0% 0.2%

Deep Sternal Infection 0.6% 1.2% 1.4% 0.0% 0.8%

Septicaemia 1.1% 1.2% 4.1% 14.3% 1.3%

Return to theatre (all cause) 3.8% 4.6% 12.3% 0.0% 4.4%

Re-op for Bleeding 2.1% 1.9% 5.4% 0.0% 2.1%

Peri-operative AMI 0.8% 0.9% 1.4% 14.3% 0.9%

New Cardiac Arrhythmia 29.5% 28.7% 37.0% 42.9% 29.5%

Pneumonia 3.5% 5.0% 11.0% 42.9% 4.4%

GIT complication 1.8% 2.4% 2.7% 0.0% 2.0%

Multi-system Failure 0.4% 0.7% 4.1% 0.0% 0.6%

Anticoagulant complication 0.4% 0.3% 5.5% 0.0% 0.5%

Red Blood Cells transfused 33.9% 38.8% 63.0% 85.7% 36.8%

Non-RBC blood products 17.5% 16.4% 46.6% 71.4% 18.4%


Intubation Time <=10hrs 69.5% 65.0% 43.1% 0.0% 66.8%

10-20hrs 23.6% 26.4% 25.0% 28.6% 24.6%

>20hrs 6.9% 8.6% 31.9% 71.4% 8.7%


<= 5 days 34.6% 29.6% 23.3% 28.6% 32.5%

5-10 days 56.6% 56.1% 50.7% 42.9% 56.2%

>10 days 8.8% 14.2% 26.0% 28.6% 11.3%

Intensive Care Stay

<=24hrs 61.9% 62.9% 38.9% 14.3% 61.3%

>24hrs –4 days

34.8% 31.4% 34.7% 71.4% 33.8%

> 4 days 3.3% 5.7% 26.4% 14.3% 5.0%


Isolated CABG data

Morbidity

BY OPERATIVE STATUS AND CARDIAC SURGERY UNIT


No. cases

A 405B 347C 307D 195E 250F 518

Total 2022

Isolated CABG data

Morbidity

BY PRE-OPERATIVE AMI


Pre-op AMI Time since AMI Total

Yes No <6hrs 6-24hrs 1-7days7-

21days>21days

n 1051 970 17 12 149 166 706 2022

New Renal Failure 4.1% 2.9% 5.9% 0.0% 6.7% 3.0% 3.8% 3.5%

Cerebrovascular complication 1.1% 1.1% 0.0% 0.0% 1.3% 0.0% 1.4% 1.1%

Permanent Stroke 0.7% 0.6% 0.0% 0.0% 0.7% 0.0% 0.9% 0.6%

Transient Stroke 0.5% 0.4% 0.0% 0.0% 0.7% 0.0% 0.6% 0.4%

Continuous Coma 0.3% 0.2% 0.0% 0.0% 0.7% 0.0% 0.3% 0.2%

Deep Sternal Infection 1.0% 0.6% 0.0% 0.0% 1.3% 0.6% 1.1% 0.8%

Septicaemia 1.3% 1.2% 0.0% 0.0% 1.3% 1.8% 1.3% 1.3%

Return to theatre (all cause) 4.9% 3.7% 5.9% 8.3% 9.4% 0.6% 4.8% 4.3%

Re-op for Bleeding 2.1% 2.1% 5.9% 0.0% 2.7% 0.0% 2.4% 2.1%

Peri-operative AMI 1.3% 0.4% 5.9% 8.3% 1.3% 1.8% 1.0% 0.9%

New Cardiac Arrhythmia 28.1% 31.1% 47.1% 33.3% 24.2% 24.1% 29.2% 29.6%

Pneumonia 4.8% 4.0% 11.8% 16.7% 6.7% 5.4% 3.8% 4.4%

GIT complication 1.5% 2.6% 0.0% 0.0% 2.7% 1.2% 1.4% 2.0%

Multi-system Failure 0.9% 0.4% 0.0% 8.3% 2.0% 0.6% 0.6% 0.6%

Anticoagulant complication 0.3% 0.8% 11.8% 0.0% 0.0% 0.6% 0.0% 0.5%

Red Blood Cells transfused 38.7% 34.6% 64.7% 58.3% 43.0% 36.1% 37.3% 36.7%

Non-RBC blood products 19.0% 17.6% 58.8% 41.7% 22.1% 13.3% 18.4% 19.1%


Intubation Time <=10hrs 64.8% 68.9% 29.4% 33.3% 57.2% 71.8% 66.3% 66.8%

10-20hrs 24.8% 24.4% 29.4% 33.3% 25.5% 20.9% 25.3% 24.6%

>20hrs 10.3% 6.7% 41.2% 33.3% 17.2% 7.4% 8.4% 8.6%


<= 5 days 31.4% 33.7% 29.4% 16.7% 30.9% 37.3% 30.5% 32.5%

5-10 days 56.1% 56.3% 52.9% 58.3% 47.7% 51.8% 58.9% 56.2%

>10 days 12.5% 10.0% 17.6% 25.0% 21.5% 10.8% 10.6% 11.3%

Intensive Care Stay

<=24hrs 58.1% 64.8% 41.2% 41.7% 56.2% 59.4% 58.8% 61.3%

>24hrs –4 days

36.0% 31.4% 35.3% 41.7% 30.8% 35.8% 37.1% 33.8%

> 4 days 6.0% 3.8% 23.5% 16.7% 13.0% 4.8% 4.1% 4.9%


Isolated CABG data

Morbidity

MISCELLANEOUS


Gender Redo Off-pump Pre-op creatinine Total

Male Female 1st proc RedoOff-

pumpOn-

pump<=0.2mmol/L

>0.2mmol/L

n 1514 508 1925 97 284 1738 1968 52 2022

New Renal Failure 3.2% 4.3% 3.4% 5.2% 3.2% 3.6% 3.1% 17.3% 3.5%

Cerebrovascular complication

1.2% 1.0% 1.1% 1.0% 0.7% 1.2% 1.1% 3.8% 1.1%

Permanent Stroke 0.6% 0.8% 0.7% 0.0% 0.4% 0.7% 0.6% 3.8% 0.6%

Transient Stroke 0.6% 0.0% 0.5% 0.0% 0.4% 0.5% 0.5% 0.0% 0.4%

Continuous Coma 0.1% 0.6% 0.2% 1.0% 0.0% 0.3% 0.3% 0.0% 0.2%

Deep Sternal Infection 0.8% 1.0% 0.8% 2.1% 0.4% 0.9% 0.8% 3.8% 0.8%

Septicaemia 1.2% 1.6% 1.2% 3.1% 0.7% 1.4% 1.1% 9.6% 1.3%

Return to theatre (all cause) 4.3% 4.5% 4.2% 7.3% 2.8% 4.6% 4.2% 9.6% 4.4%

Re-op for Bleeding 2.4% 1.4% 2.1% 2.1% 1.4% 2.2% 2.1% 1.9% 2.1%

Peri-operative AMI 0.9% 1.0% 0.9% 0.0% 0.7% 0.9% 0.9% 0.0% 0.9%

New Cardiac Arrhythmia 28.9% 31.5% 29.6% 29.2% 22.2% 30.7% 29.4% 34.6% 29.5%

Pneumonia 4.1% 5.3% 4.4% 5.2% 2.8% 4.7% 4.3% 9.6% 4.4%

GIT complication 2.0% 2.0% 2.0% 2.1% 1.8% 2.1% 2.0% 3.8% 2.0%

Multi-system Failure 0.5% 1.2% 0.6% 1.0% 0.0% 0.7% 0.6% 1.9% 0.6%

Anticoagulant complication 0.7% 0.2% 0.6% 0.0% 0.0% 0.6% 0.6% 0.0% 0.5%

Red Blood Cells transfused 32.5% 49.4% 36.6% 40.6% 16.2% 40.1% 36.1% 59.6% 36.8%

Non-RBC blood products 19.4% 15.4% 18.2% 22.9% 4.6% 20.7% 18.1% 25.0% 18.4%


Intubation Time <=10hrs 68.5% 61.6% 67.3% 55.8% 81.6% 64.5% 67.2% 51.0% 66.8%

10-20hrs 23.1% 28.9% 24.4% 28.4% 15.3% 26.0% 24.2% 37.3% 24.6%

>20hrs 8.4% 9.4% 8.3% 15.8% 3.1% 9.5% 8.5% 11.8% 8.7%


<= 5 days 34.7% 25.8% 33.1% 20.6% 51.8% 29.3% 32.9% 17.3% 32.5%

5-10 days 55.2% 59.1% 55.8% 63.9% 40.8% 58.7% 56.6% 42.3% 56.2%

>10 days 10.0% 15.2% 11.1% 15.5% 7.4% 12.0% 10.5% 40.4% 11.3%

Intensive Care Stay

<=24hrs 62.3% 58.1% 61.4% 58.3% 61.2% 61.3% 61.7% 45.1% 61.3%

>24hrs –4 days

33.2% 35.4% 33.9% 31.3% 36.6% 33.3% 33.9% 31.4% 33.8%

> 4 days 4.5% 6.5% 4.7% 10.4% 2.2% 5.4% 4.5% 23.5% 5.0%


Other Group data

Total number of procedures Mortality (30 days post op) by procedure

Surgery type (NOT mutually exclusive)


% of total procedures

Number of patients

% of Surgery type

Left Ventricular Aneurysm 31 1.2% 2 6.5%Acquired VSD 8 1.2% 2 25.0%

Aortic 98 3.3% 13 13.3%

Aneurysm – Asc only 41 1.4% 0 0.0%

– Asc + arch 9 0.3% 0 0.0%

– Arch only 0 0.0%

– Desc 3 0.1% 0 0.0%

– Thor/abd only 5 0.2% 3 60.0%

– Other 2 0.1% 0 0.0%

Disection – Asc – Acute 28 0.9% 9 32.1%

– Asc – Chronic 2 0.1% 0 0.0%

– Desc – Acute 2 0.1% 0 0.0%

– Desc – Chronic 1 <0.1% 0 0.0%Acute Traumatic Aortic Transection

8 0.3% 1 12.5%

Congenital - ASD 28 0.9% 1 2.9%

- Other 14 0.5% 0 0.0%

Cardiac Trauma 8 0.3% 3 37.5%

Pericardiectomy 6 0.2% 0 0.0%

Cardiac Tumour 11 0.4% 0 0.0%


Factors contributing to Morbidity in the Whole Population

BY AGE

Age Group<40

years40-49 yrs 50-59 yrs 60-69 yrs 70-79 yrs 80+ yrs Total

n 106 214 586 894 981 193 2974





Continuous Coma 1.0% 1.9% 0.2% 0.3% 0.6% 1.0% 0.6%




10-20hrs 19.2% 15.9% 22.3% 25.8% 29.8% 30.0% 25.8%

>20hrs 30.3% 12.0% 9.0% 11.8% 14.0% 19.5% 13.2%


<= 5 days 31.1% 41.6% 42.0% 27.0% 18.1% 11.9% 27.2%

5-10 days 29.2% 47.2% 46.4% 55.7% 61.0% 56.0% 54.1%

>10 days 39.6% 11.2% 11.6% 17.3% 20.9% 32.1% 18.7%

Intensive Care Stay

<=24hrs 40.8% 58.2% 63.0% 55.3% 52.9% 36.6% 54.5%

>24hrs –4 days

37.9% 33.3% 31.2% 36.3% 38.8% 47.6% 36.7%

> 4 days 21.4% 8.5% 5.9% 8.5% 8.3% 15.7% 8.8%



BY PROCEDURE TYPE

Procedure TypeIsolated CABG

Valve(s) onlyValve(s) +

CABGOther Total

n 2022 366 238 348 2974


Deep Sternal Infection 0.8% 0.0% 0.8% 0.9% 0.7%


Red Blood Cells transfused 36.8% 43.4% 66.4% 59.2% 42.6%

Non-RBC blood products transfused

18.4% 28.4% 44.1% 49.4% 25.3%


10-20hrs 24.6% 29.1% 32.5% 24.3% 25.8%

>20hrs 8.7% 9.7% 22.8% 36.6% 13.2%


<= 5 days 32.5% 17.2% 9.2% 19.5% 27.2%

5-10 days 56.2% 60.7% 51.7% 36.5% 54.1%

>10 days 11.3% 22.1% 39.1% 44.0% 18.7%

Intensive Care Stay

<=24hrs 61.3% 53.0% 34.2% 30.2% 54.5%

>24hrs – 4 days

33.8% 39.6% 48.9% 42.3% 36.7%

> 4 days 5.0% 7.4% 16.9% 27.5% 8.8%



BY LV FUNCTION

LV Dysfunction

Normal Mild Moderate Severe Total

n 1177 875 490 380 2922





Continuous Coma 0.4% 0.2% 0.6% 1.3% 0.5%


10-20hrs 27.1% 25.1% 29.3% 19.3% 25.9%

>20hrs 9.4% 9.5% 14.1% 28.6% 12.7%


<= 5 days 29.4% 28.8% 20.0% 26.9% 27.3%

5-10 days 54.6% 55.3% 59.9% 44.9% 54.4%

>10 days 16.0% 15.9% 20.2% 28.2% 18.3%



BY DIABETES

Diabetes

Yes No Total

n 827 2144 2971

Cerebrovascular complication 1.7% 2.5% 2.3%

Permanent Stroke 1.5% 1.3% 1.3%

Transient Stroke 0.1% 0.8% 0.6%

Continuous Coma 0.2% 0.7% 0.6%

Deep Sternal Infection 1.6% 0.4% 1.7%

BY STATUS

Operative Status

Elective Urgent Emergency Salvage Total

n 1908 886 155 25 2974


Stroke permanent 1.1% 1.0% 5.2% 4.5% 1.3%


Continuous Coma 0.2% 0.3% 5.8% 9.1% 0.6%



<= 5 days 28.4% 25.8% 18.7% 40.0% 27.2%

5-10 days 58.0% 50.5% 32.9% 16.0% 54.1%

>10 days 13.6% 23.7% 48.4% 44.0% 18.7%



BY REDO

Redo

1st Proc Redo Total

n 2743 231 2974

Re-op for Bleeding 3.1 3.5 3.2

Intubation Time <=10hrs 62.3% 46.0% 61.1%

10-20hrs 25.8% 25.9% 25.8%

>20hrs 11.9% 28.1% 13.2%


<= 5 days 28.3% 15.2% 27.2%

5-10 days 54.4% 50.6% 54.1%

>10 days 17.4% 34.2% 18.7%

BY RESPIRATORY DISEASE

Respiratory Disease

No Mild Moderate Severe Total

n 2458 408 75 27 2968

Deep Sternal Infection 0.6% 1.5% 1.3% 0.0% .7%


10-20hrs 25.8% 24.1% 33.3% 23.1% 25.8%

>20hrs 12.3% 15.7% 17.3% 38.5% 13.2%



MISCELLANEOUS

Previous Cerebrovascular Disease Atrial Arrythmia

Yes No Total Yes No Total

n 319 2651 2970 319 2655 2974

Cerebrovascular complication 5.3% 1.9% 2.3% 4.7% 2.0% 2.3%

Permanent Stroke 2.5% 1.2% 1.3% 2.2% 1.2% 1.3%

Transient Stroke 1.3% 0.6% 0.6% 0.6% 0.6% 0.6%

Continuous Coma 2.5% 0.3% 0.5% 2.2% 0.4% 0.6%

CPB time0 hrs >0 - 1hr >1 – 3 hrs >3 hrs Total

n 308 139 2272 274 2973




Continuous Coma 0.0% 0.0% 0.4% 3.0% 0.6%

BITA ObesityReturn to theatre

(all cause)

Yes No Total Yes No Total Yes No Total

n 318 2652 2970 186 2784 2970 848 2122 2970

Deep Sternal Infection 2.5% 0.5% 0.7% 7.0% 0.3% 0.7% 1.1% 0.6% 0.7%

Pre-op anti-plateletYes No Total

n 1226 1746 1972

Re-op for bleeding 3.3 3.1 3.2


The ASCTS Database software contains an In-House reporting module, which

provides a report on case numbers and outcomes for the individual unit as required.

The following pages display a copy of that report generated by the same software, but

for all units data combined.

The report is provided here to allow individual units to compare the report generated

at their own site to that from the whole state.

PLEASE NOTE: minor discrepancies between the report from the In-House reporting

module and the Comprehensive Surgeon’s Report are the result of differences in

filtering processes prior to analysis whereby cases are excluded.


In-house reporting module – report from all units combined


The following pages outline formal processes relating to the conduct of the project.

These include:

Data management

Peer Review mechanism

Data collection form

Patient Information Sheet

Opt-off procedure


Processes

Data Management

All data collected as part of the ASCTS project is forwarded to the Baker Heart

Research Institute. The flow of information into the data centre is outlined in the

following figure.


Surgical Unit

Surgical Unit

Surgical Unit

Surgical Unit

Surgical Unit

Interim

Unit

Registry

ErrorCorrection

Final

Unit

Registry

Merged

State

Registry

Current Peer Review Mechanism for identification of Unit outliers


STEP 1: Identification of outlier on Control ChartWeek 0

STEP 2: Unit contacted and asked to undertake internal review of the past 3 months data and report within 4 weeksWeek 4

STEP 3: CDA reviews local audit report and discusses results with UnitWeek 8

STEP 4: Review most recent KPI data: Result within limits - No action requiredKPI remains out of rangeWeek 12

STEP 5: Unit contacted and asked to agree to external review of the past 3 months data and report within 4 weeksWeek 16

STEP 6: CDA reviews external audit report and discusses results with UnitWeek 20

STEP 7: Review most recent KPI data: Result within limits - No action requiredKPI remains out of rangeWeek 24

STEP 8: Unit contacted and meeting arranged with hospital administration and Department of Health

Data Collection Form

GENERAL DESCRIPTIONThe following pages show the ASCTS Data Collection Form. This form contains only the ASCTS Minimum Dataset. Individual Hospitals may have a slightly different form depending on the type and amount of additional data each Hospital wishes to collect.

The ASCTS Data collection form consists of 3 parts: Pre operative, Intra Operative and Post Operative.

Pre Operative: We recommend that this section of the form should be completed by the Resident. This part of the form contains information on the patient’s demographics, risk factors, pre operative cardiac status and previous interventions.

Intra Operative: We recommend that this section of the form should be completed by the Surgeon.This part of the form contains information on the patient’s haemodynamic data, operative status, and information directly related to the procedure performed.

Post Operative:We recommend that this section of the form should be completed by the Registrar.This part of the form contains information on post operative complications and mortality.

We also recommend that the Data Manager check all parts of the form for completeness and make any amendment as required.

Each part is contained on separate pages from the other parts. They can therefore be separated from each other for the purposes of data collection if required.

IMPORTANT INSTRUCTIONS FOR FILLING IN THE FORMSThe form has been designed for the purposes of scanning. During the first phase of the project the form will be submitted to The Baker Institute for the purposes of data entry into the ASCTS Database. As a scan form it is important that the form be completed in the following manner:

Complete the form with an ink pen (preferably black). Enter any values such as numbers or letters within the boxes, with one character per box. Enter letters and block letters (capitals). Shade in the circles for yes/no questions and multiple-choice questions. Do NOT tick or

cross them.

SUBMISSION OF DATA TO THE ASCTS PROJECTWhen all 3 parts of the form have been completed and checked this should be indicated on the top of the first page. The entire form should then be faxed to 1800 650 573.


Data Collection Form – Pre Operative page 1


Data Collection Form – Pre Operative page 2


Data Collection Form – Intra Operative page 1


Data Collection Form – Intra Operative page 2


Data Collection Form – Post Operative


Patient Information Sheet

ADULT CARDIAC SURGERY DATABASE

IntroductionYou are about to have a cardiac surgery operation. Generally heart surgery is successful in improving the quality and length of the patient’s life, with a small risk of death or major complications. However, in certain people the surgery is less successful. This may be due to some people having characteristics that increase their risk of complications, or it may be due to the type of operation done and the circumstances in which it is performed.

In order to improve the success of heart surgery we need to know what factors increase a patient’s risk of complications, and which surgical procedures have the most successful outcome. To achieve this, the Victorian branch of the Australian Society of Cardiac and Thoracic Surgeons (ASCTS) has set up a Cardiac Surgery Database to monitor the results of cardiac operations.

The database aims to record information on every adult having a cardiac surgery operation. The success of the database depends on the amount of data we collect. We are asking you to participate in the Cardiac Surgery Database, by allowing us to document information relevant to your operation.

What Information Do We Need?The information we require includes your name, date of birth, Medicare Number, hospital identification number, the name of the hospital the reason you are having cardiac surgery and other information directly related to your proposed operation. All of your information will be freely available to you.

We Will Keep Your Information ConfidentialYour personal information is confidential and cannot be used outside the database. Procedures are in place to protect your information and keep it confidential. Registry data is accessible by authorised staff of the Cardiac Surgery Database project. Aggregate data will be made available through the reporting system of ASCTS. You cannot be identified in any reports produced by the registry.

How We Will Collect The Information?You are not required to do anything. The hospital staff will complete the forms that contain your details during your hospital stay. The information will be entered onto the database computer.

Risk And Benefits – To YouYour information is protected and we are not allowed to identify you by law. The database will produce general reports on the success of surgery which we anticipate will improve the quality of cardiac surgery in the future. Having your data entered into the Database will not alter the care and treatment you receive for your current surgery in any way.

You Can Choose Not To Be In The DatabaseWe understand that not everyone is comfortable about having details related to their cardiac condition documented in a database. If you feel this way, and do not want this information added to the database, please contact the Project Co-ordinator on 1800 998 722 within two weeks of the operation. (You can always have your information removed from the database later simply by contacting the Project Co-ordinator) A decision on whether or not you wish to be involved in the registry does not affect your treatment in any way.

If you have any questions, concerns or require further information about the Cardiac Surgery Database, please do not hesitate to contact the Project Co-ordinator on 1800 998 722.


Consent procedure

In order to “Opt-off” from the ACST Cardiac Surgery Project, the patient, or their representative must call the 1800 number provided to him/her on the Patient Information Sheet.

An “Opt-off” cannot be done by staff at the hospital where the patient is undergoing the cardiac procedure.

The following procedure will be followed by the Project Manager when patient’s ring the 1800 number to request that they not be included in the ASCTS Cardiac Surgery Project. This is provided here in case the patient wishes to have more information about the Opt-off procedure prior to calling the 1800 number.

Procedure For Processing Opt-Out Requests

1. Obtain Name, date of birth, Hospital where surgery was performed, approximate date that surgery was performed and contact phone number. (in order to identify the record to be deleted).

2. Ask if the patient has any questions about the database or would like any further explanation of how and why the data is collected.

3. Ask the Patient “Would you like me to not add your information to the Register?”

4. Ask the patient “You do not have to tell me, but may I ask you why you would not like your information to be included in the database?”

5. After receiving the answer to the above question DO NOT offer any more explanations or try to change the patient’s mind – the patient’s decision is final.

6. Thank the patient – notify them that if they undergo a new surgical procedure they will need to Opt-off again. We will not be retaining the patient’s details if the data is not added – We will however retain the information that a patient who underwent a surgical procedure at that hospital in the calendar month of the Date of Surgery withdrew their data from the database, and the reasons for withdrawal.

7. Check the database for the appropriate record. If a near match is found but not sure then contact the patient to confirm. If a match is not found then retain the information until the record arrives (records will not be received until at least 1 month post surgery).


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