Cardiothoracic Audit Update Doug West

Members across all subspecialties in cardiothoracic surgery should expect to see quite significant changes in national audit and reporting structures this year.

The 2021 NACSA/NICOR report has recently been released. Overall surgical activity is still decreasing, with 13% fewer cases reported than five years ago. There is some evidence of worsening access to care, with both elective and urgent waiting times increasing slightly. Just over half of all CABG operations are now performed urgently, but there are still difficulties achieving rapid access to urgent surgery. No hospital met the target of operating on more than 75% of urgent patients within 7 days of angiography. There have been other quality improvements, with an increase in day of surgery admission rates and a fall in already low rates of bleeding after CABG, now at 1.8%. This year’s report includes data from the Scottish centres, although NICOR has been notified that in future Public Health Scotland will be responsible for publishing the results of cardiac surgery in Scotland.

The Society’s collaboration with NICOR to develop the unit quality programme is making good progress. 34 units have now responded to the unit questionnaire. Preliminary work on this project and mockups of the data visualisation were presented by Uday Trivedi at BORS.

The latest NICOR report was released in October. Reassuringly, no outlier units were identified. After some concerns last year about standardisation of reporting, rates of neurological injury after surgery have not been reported this year. A NACSA working group, including SCTS deputy congenital audit lead Serban Stoica, are looking at improving the reporting of this metric.

HQIP are currently recommissioning the NACSA audit, and some changes in delivery of the audit are anticipated. Final details are awaited.

NICOR data for the long-awaited SCTS Blue Book in congenital surgery was released to the University of Birmingham (who the Society have commissioned to analyse data for the Blue Book) recently. We are hopeful that the Blue Book, containing many years of UK congenital heart surgery data, can now progress. This will be a major SCTS project, funded and delivered by the Society, joining the adult cardiac and thoracic blue books in recent years.

We are looking at developing a SCTS database manger’s educational event, to help database managers update on recent reporting changes.

The latest LCCOP report, covering prepandemic 2018 data, was published recently. The report documents the progress made in recent years, with the highest number of cases, lowest 30 day and one year mortality ever reported. No units were outliers. The Society were able to obtain funding from industry to support publication of the LCCOP report, and we were able to distribute hard copies to all SCTS audit leads recently. Email me if you want a copy- there are a handful left.

Despite these successes, 2021 was the last year of the LCCOP project. The National

Lung Cancer Audit (who delivered LCCOP with the support of the SCTS) has been recommissioned, and will now be delivered through the Clinical Evaluation Unit at the Royal College of Surgeons of England. Previously it was delivered by the College of Physicians. SCTS have worked closely and productively with the CEU before, for example in the pilot HES project reported in the third thoracic Blue Book, and we look forward to collaborating with the new providers. Reductions in HQIP funding – LCCOP is not included in the commission – will inevitably mean a change in “The next few years will be the report structure. This may be an opportunity to increase cross-challenging, making sure that disciplinary reporting (for example, stage-specific adjuvant therapy we maximise the learning from rates), and we hope it will continue the focus on reporting the results of the pandemic without unfair integrated clinical teams. criticism of units and teams The call for SCTS returns data for the 2020-2021 audit year is due that were most hard-hit.” out imminently. This will be very important data, as the effects of the pandemic start to come through. Please get your activity back to KS Rammohan. We aim to get preliminary data out at the Belfast Meeting in the spring.

The next few years will be challenging, making sure that we maximise the learning from the pandemic without unfair criticism of units and teams that were most hardhit. Recommissioning will change some of the reporting structures that you may be used to, particularly in thoracic surgery, while in adult cardiac surgery the unit quality accreditation programme is moving the focus towards an assessment of team structure and outcomes. The Society continues to produce its own significant outputs, particularly the comprehensive Blue Book programme across the three large subspecialties. We are planning some audit and QI sessions at the Belfast meeting in 2022. Do come along to explore the latest data and to meet the audit team. n