2016 Cumulative and Current Outcomes - surgery.cuhk.edu.hk€¦ · 2016 Cumulative and Current...

2016 Cumulative and Current Outcomes

• Includes: – Cardiac Surgical Activity

• Volume/Case Mix changes • Case Priority changes • Hybrid Theatre Activity 2013-2015

– All case mortality using the logistic EuroSCORE as risk predictor • Cumulative and for 2015 • Funnel Plot, Control Limit Charts • Individual Referring Center Outcomes

– Isolated CABG mortality using the SCTS Complex Bayes Score as risk predictor • Cumulative and for 2015

– Re-Operation for Bleeding • Cumulative for all cases

– New Post-Operative Stroke • ‘Runs’ Analysis 2006-current

– Blood Transfusion ‘Runs’ Analysis • Cumulative and Comparative for 2015

Cardiac Surgical Activity 2006-2015

0

50

100

150

200

250

300

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Elective

Urgent (can wait till next working day)

Emergency (cannot wait till next working day

Salvage

365

377

426

CABG alone(1514)

CABG + valve(176)

CABG + valve + other(25)

CABG + other(47)

Valve alone(1025)

Valve + other(211)

Other (334)

(2)

0

50

100

150

200

Cardiac Surgical Case Mix 2006-2015

Reduction in Isolated CABG operation and increases in complex valve and aortic interventions

Cardiac Surgical Referral Centers % of Cases : 2006-2015

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

35.00%

40.00%

45.00%

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

PWH

TMH

NDH

AHNH

POH

Others

0

20

40

60

80

100

120

140

160

CABG alone CABG + valve CABG + valve +other

CABG + other Valve alone Valve + other Aortic Other

Cardiac Surgical Case Mix 2015

Change in Operative Urgency 2006-2015

0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0% 100.0%

2006

2008

2011

2015



Elective

2015: 31% Emergency Cases

Mean 7 8.46 9.94Logistic EuroSCORE

2008 2011 2015

0

10

20

30

40

50

60

70

80

90

100

01 Jan 2006-31 Dec 2006

01 Jan 2007-31 Dec 2007

01 Jan 2008-31 Dec 2008

01 Jan 2009-31 Dec 2009

01 Jan 2010-31 Dec 2010

01 Jan 2011-31 Dec 2011

01 Jan 2012-31 Dec 2012

01 Jan 2013-31 Dec 2013

01 Jan 2014-31 Dec 2014

01 Jan 2015-31 Dec 2015

Change in Number of Aortic Interventions 2006-2015

0

10

20

30

40

50

60

Interposition tube graft

Tube graft + separate AVR

Root replacement with composite valve graft andcoronary rei

Endovascular stenting

Change in Type of Aortic Intervention 2006-2015

TEVAR Programme funded 2010

Hybrid Theatre 507 Throughput

0

50

100

150

200

250

2013 2014 2015

Total activities

Total activities

PWH • Cardiovascular Hybrid OR

0.00

100.00

200.00

300.00

400.00

500.00

600.00

700.00

1 2 3

Isolated Valve Surgery 2006-2015 Crude Mortality 2.8% (expected log EuroSCORE 6.2%)

Number of Valves

211 patients had AVR/MVR +/_ TVR with crude mortality of 4.2% (cf 6.9% UK SCTS: expected log EuroSCORE PWH 6.9%)

Funnel Plot All Cases 2006-current (UK SCTS Alert Lines)

Control Limit Plot All Cases 2006-Current

Number of cases 3537 <----enter value here

Number of deaths 129 <----enter value here

Observed mortality 3.65%

Performance definitely better than expected

Expected mortality 7.60% <----enter value here

(=average Euroscore

for these cases)

Upper control limits

2 s.d. 8.51%

3 s.d. 8.96%

3.5 s.d. 9.22%

4 s.d. 9.44%

Lower control limits

2 s.d. 6.73%

3 s.d. 6.30%

3.5 s.d. 6.08%

4 s.d. 5.88%

Control Limit Plot All isolated CABG 2006-Current






(=average Euroscore

for these cases)


2 s.d. 4.93%

3 s.d. 5.43%

3.5 s.d. 5.68%

4 s.d. 5.99%


2 s.d. 3.00%

3 s.d. 2.56%

3.5 s.d. 2.31%

4 s.d. 2.12%

Control Limit Plot All Cases 2015






(=average Euroscore

for these cases)


2 s.d. 12.91%

3 s.d. 14.55%

3.5 s.d. 15.26%

4 s.d. 16.20%


2 s.d. 7.04%

3 s.d. 5.87%

3.5 s.d. 5.16%

4 s.d. 4.69%

Control Limit Plot isolated CABG 2015




Performance as expected


(=average Euroscore

for these cases)


2 s.d. 6.94%

3 s.d. 9.03%

3.5 s.d. 9.72%

4 s.d. 11.11%


2 s.d. 0.69%

3 s.d. 0.00%

3.5 s.d. 0.00%

4 s.d. 0.00%

CUSUM All Case Mortality 2006-Current (3575 cases): Crude Mortality 3.6%

Actual

Expected

Deaths

Years

0

50

100

150

200

250

300

2005 2007 2010 2014 2015

2006 2008 2009 2011 2012 2013 2016

Logistic EuroSCORE as predictor

CUSUM CABG Mortality 2006-Current (1602 cases): Crude Mortality 1.7%

Actual

Expected

Deaths

Years

0

10

20

30

40

50

60

2006 2007 2009 2013

2010 2011 2012 2014 2016

SCTS Complex Bayes as predictor

Actual

Expected

Mortality

Years

0

5

10

15

20

25

30

2007 2010 2011 2013

2009 2014 2016


CUSUM Elective CABG Mortality 2006-Current (1196 cases) Crude Mortality: 0.9%

CUSUM All Case Mortality 2015 (426 cases): Crude Mortality 2.8%

Logistic EuroSCORE as predictor

Actual

Expected

Deaths

Years

0

10

20

30

40

2015

Actual

Expected

Deaths

Years

0.0

0.5

1.0

1.5

2.0

2.5

3.0

2015


CUSUM CABG Mortality 2015 (144 cases): Crude Mortality 1.3%

Actual

Expected

Re-Ops

Years

0

50

100

150

200

2005 2007 2010 2014

2006 2008 2009 2011 2012 2013 2015 2016

CUSUM Re-Operation for Bleeding 2006-Current (3575 cases): Crude Rate 4.4 %

Actual

Expected

ReOps

Years

0

20

40

60

80

2005 2007 2009 2012 2013 2015

2008 2010 2011 2014 2016

CUSUM Re-Operation for Bleeding CABG 2006-Current ( 1602 cases): Crude Rate 2.4 %

Actual

Median

1 or >

Unit

0

10

20

30

40

50

60

24 MAY 06 12 APR 08 21 JAN 10 22 SEP 11 8 APR 13 6 NOV 14 22 JUL 16

23 APR 07 23 MAR 09 26 NOV 10 26 JUN 12 20 JAN 14 30 AUG 15

Runs Analysis for ICU Blood Transfusion 2006-2016 (3575 cases)

70% Transfusion Free

Runs Analysis for ICU Blood Transfusion 2015 (All Cases)

70% Transfusion Free

Actual

Median

>1 Unit

Transfused

0

10

20

30

40

50

29 JAN 15 13 APR 15 9 JUN 15 29 JUL 15 21 SEP 15 12 NOV 15 31 DEC 15

11 MAR 15 18 MAY 15 2 JUL 15 25 AUG 15 15 OCT 15 7 DEC 15

Runs Analysis New Post-Operative Stroke 2006-Current (crude rate 2.6%)

Actual

Median

%

CVA

0

2

4

6

8

4 OCT 07 7 DEC 09 13 JUN 11 28 AUG 12 12 DEC 13 20 MAR 15 22 JUL 16

8 JAN 09 14 SEP 10 8 FEB 12 29 APR 13 17 JUL 14 19 OCT 15

Supplementary Reports: PWH Referrals 2006-current

1011

225

124

18

Elective



Salvage

Number of Cases Referred


Procedures Performed

0

100

200

300

400

500

600

CABG alone CABG + valve CABG + valve+ other

CABG + other Valve alone Valve + other Aortic


Mortality Control Plot

Supplementary Reports: TMH Referrals 2006-current


889

188

96

9

Elective



Salvage



0

100

200

300

400

500

600

700



Supplementary Reports: NDH Referrals 2006-current


233

70

67

1

Elective



Salvage



0

20

40

60

80

100

120

140

160








Performance slightly low - probably normal


(=average Euroscore

for these cases)


2 s.d. 12.37%

3 s.d. 14.25%

3.5 s.d. 15.05%

4 s.d. 15.86%


2 s.d. 6.45%

3 s.d. 5.11%

3.5 s.d. 4.57%

4 s.d. 4.03%

2016 Cumulative and Current Outcomes - surgery.cuhk.edu.hk€¦ · 2016 Cumulative and Current...

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