Oxford hospital suspends paediatric cardiac surgery after four deaths

The John Radcliffe Hospital has suspended paediatric cardiac surgery while it investigates the deaths of four children who had operations at the hospital in the past three months.

In a statement, the hospital says its paediatric cardiac surgery service has been temporarily suspended while it investigates concerns that have been raised. “Our investigations are likely to include an external review of the deaths of some very sick children (four children) who underwent surgery at the John Radcliffe Hospital in the last three months,” it said.

The outcomes for paediatric cardiac surgery in the United Kingdom are monitored nationally by the Central Cardiac Audit Database, which requires hospitals to provide data on all children who undergo cardiac surgery. The John Radcliffe Hospital said that its figures are “within normal outcome ranges.”

“Any hospital might, at some time, have a run of deaths in a service that provides treatment for patients who are very unwell. However, it is right that we take a pause while we look into the individual cases, to see if there is anything to learn from them,” the hospital statement said.

A spokeswoman for the hospital said that the four children who had died all had congenital heart disease and had undergone a range of different types of surgery to correct cardiac abnormalities. They were all “very sick,” she said. The hospital carries out an average of about 100 cardiac surgery procedures on children with congenital heart problems every year.

All four of the children who died were operated on by the same surgeon, but the spokeswoman said, “At this point, we would emphasise that the surgeon is part of the whole service.” The involvement of one surgeon was not the issue that had prompted the investigation, she said.

The hospital took the decision to suspend paediatric cardiac surgery internally, after discussion with clinical staff. Nothing specific about the deaths of the four children had raised concerns, the spokeswoman said, other than the number of deaths. She explained, “The inquiry into the deaths of children in Bristol recommended that a run of deaths should trigger an investigation—whether or not there is a specific problem.

“As we had four deaths, we decided that we needed to look at the service as a whole to ensure there is not a problem,” she said.

The Care Quality Commission, the independent regulator of health services, is monitoring the situation “extremely closely.” Roxy Boyce, regional director for the commission, commented, “This is high risk surgery and the trust is taking the right steps in conducting a review.”

Leslie Hamilton, consultant cardiac surgeon at the Freeman Hospital, Newcastle, and president of the Society for Cardiothoracic Surgery, said, “All units undertaking paediatric cardiac surgery take the monitoring of cardiac outcomes very seriously. This action shows that clinical governance procedures are working.”

Mr Hamilton added that the lack of a risk scoring system to separate high risk from low risk children undergoing cardiac surgery is a problem. However, he noted, “Cardiac surgery in children is always challenging because of the range of congenital cardiac conditions that are operated on. A lot of decision making can’t be done in advance—despite imaging—because you have to assess the anatomy when you are operating,” he said. “This means there is generally no routine way to operate.”

The John Radcliffe Hospital is currently in the process of developing the scope for the investigation, but it will include the whole of the patient pathway, the spokeswoman said. Staff are contacting the families of children who are waiting for cardiac surgery and those who need urgent surgery will be treated at other hospitals.

The hospital was reviewed in 2007 for its high death rate among adults undergoing cardiac surgery. The Healthcare Commission (the regulator at that time) began an investigation after figures showed that the number of patients who died between April 2002 and March 2005 after their first coronary artery bypass graft at the hospital was more than double the national average—4.01% compared with 1.83%.

The Commission said at the time that while death rates at the John Radcliffe’s cardiac surgery unit were “acceptable” improvements were needed. It recommended that the Trust should ensure greater consistency in the models of care used to manage high risk patients.