Bristol's heart death rate 'twice UK average'

HAREFIELD HOSPITAL in Middlesex, made famous by the heart transplant pioneer Sir Magdi Yacoub, announced a review of its surgical procedures yesterday after it was found to have a higher than average death rate for children aged over one.

The Royal Brompton and Harefield Trust announced the review as figures presented to the public inquiry into the Bristol heart babies scandal showed that children who underwent complex heart surgery at the Bristol Royal Infirmary between 1988 and 1995 were twice as likely to die as those treated in other centres. The death rate for the infirmary was higher than for the 11 other specialist centres carrying out similar surgery. For babies under one, the death rate was four times higher.

The Royal Brompton trust recently completed a review of the Brompton hospital's results for heart surgery on children following an anonymous allegation that they were worse than elsewhere. The review found that in most cases the Brompton had better results than other centres.

By contrast, the statistical analysis presented to the Bristol inquiry provides the first confirmation that Bristol's record was worse than elsewhere between 1988 and 1995. Allegations about its poor performance underpinned the disciplinary action by the General Medical Council against the former surgeons James Wisheart and Janardan Dhasmana and the former chief executive John Roylance last year, but they have not been backed by hard data until now.

Heart surgery on children in the city is now carried out at the Bristol Children's Hospital under a new surgical team and its death rate is among the lowest in the country.

Brian Langstaff QC, the senior inquiry counsel, warned yesterday that the statistics were only part of the jigsaw in the investigation into the care of children undergoing complex surgery at the infirmary over the 12 years to 1995. He said the figures "can only be part of a picture. They can suggest an explanation is called for. They cannot explain". He warned that much of the data was incomplete and not validated.

One set of data showed the death rate at Bristol for the "switch" operation, used to correct malformation of the arteries, was 58 per cent compared with a national figure of 10 per cent. For hole-in-the-heart surgery, the Bristol death rate was 35 per cent compared with a national average of 8 per cent. Bristol did not appear to be operating on more severe cases but did have an apparently higher proportion of Down's syndrome children.

Mervyn Fudge, solicitor for the Bristol Heart Children's Action Group, representing 300 families, said the figures were "truly shocking". He added: "It comes as no surprise as we have always maintained that there was a significant problem in Bristol."

Mr Langstaff said some difference in death rates was inevitable; the figures were intended to provide a general comparison. He said: "It would be unduly alarmist to conclude that Harefield was a poor hospital or to suggest this inquiry had uncovered something that had not been appreciated to an extent before."

Mark Taylor, chief executive of the Royal Brompton and Harefield Trust, said the trust had not had time to check the data and it could contain significant errors. If correct, the higher death rate was likely to be due to Harefield's readiness to accept children who had been turned away by other hospitals. "We are undertaking this review because we feel it is important to clear the air," he said.