Child heart deaths at the Bristol Royal Infirmary have fallen markedly, to below the national average, finds a study in this week's BMJ.
The Bristol inquiry between 1991 and 1995 showed that Bristol had a much higher death rate for open heart surgery in children aged under 1 year than other major centres. Since then, there have been major changes in the child cardiac surgery service.
Researchers at Imperial College London analysed data on the performance of United Bristol Healthcare Trust and that of the other major centres in England since 1991. They identified over 8,000 open operations between April 1991 and March 2002 in children under 1 year and over 11,000 in children aged 1-15 years.
Mortality for all centres combined fell from 12% between April 1991 and March 1995 to 4% between April 1999 to March 2002. Mortality in children under 1 year at Bristol fell from 29% to 3% over the same time period, below the national average. The fall in mortality did not seem to be due to fewer high risk procedures or an increase in the numbers of low risk cases.
Mortality at Bristol has fallen markedly after the changes there, say the authors. Nationally, mortality has also fallen. "Improved quality of care may account for the drop in mortality, through new technologies or improved perioperative and postoperative care, or both," they conclude.
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