A Medical Device Daily

Heart care units in the United Kingdom have signed up for what healthcare officials are calling “the most rigorous and transparent regime” ever for testing their performance. And their performance, in terms of survival rates, is within the range expected.

Last year, heart surgeons belonging to the Society of Cardiothoracic Surgeons of Great Britain and Ireland joined forces with the UK healthcare watchdog, the Healthcare Commission, to make survival rates from cardiac surgery available through a public website.

The surgeons and commission say that in the past 12 months the site has become “increasingly well-regarded,” receiving thousands of visitors each month and allowing patients to make “more informed decisions about their treatment.”

Survival rates for heart surgery in the 2005-2006 period have now been collated and the site updated. Some of the data has also been adjusted according to a new UK model for calculating expected survival rates.

Last year, the EuroScore model was used. This is an internationally recognized system that calculates expected survival rates for heart surgery, taking into account factors such as a patient’s age and the severity of his or her illness in a process known as risk adjustment.

This tempered concerns some had expressed that simply publishing crude rates of survival or death without any such adjustments would deter surgeons from operating on patients that are higher risk — the very people who are most in need of the best surgeons.

There have been suggestions, however, that EuroScore is becoming outdated, given recent improvements in technology and surgical and anesthetic techniques, and that this leads to the majority of hospitals achieving “better than expected” survival rates.

Intent on being as open and transparent as possible, heart surgery units in the UK therefore agreed to put some of this year’s figures through a new, “tougher” model for the website’s annual update. This allows patients to see how the units have performed against recent standards in the UK as well as giving an indication of their performance against accepted European standards.

Survival rates for the two most common heart operations — heart bypass and aortic valve replacement — were calculated using the new model. Every heart unit had satisfactory survival rates.

Nationally, the survival rate for heart bypass operations remains “better than expected.” Between April 2005 and March 2006 there were 20,773 such operations in England and Wales — 98.4% of patients survived, above the expected range of 97.74% to 98.32%.

And a survival rate of 98.03% for the 3,504 patients undergoing aortic valve operations was comfortably within the expected range of 96.63% to 98.20%.

Professor Ian Kennedy, chairman of the Healthcare Commission, said, “Trust between patients and doctors depends on reliable and meaningful information. Historically, it has not always been easy to obtain. This voluntary agreement by those working in cardiac surgery demonstrates how far we have come.”

He said that 38 units performing heart surgery in the UK have now signed up to the website. Moreover, they have taken the bold step of moving away from the EuroScore system.

“The new model, for measuring performance in light of the relevant risks, raises the bar in terms of assessing the quality of heart surgery in the UK. It also sets a marker for other disciplines. Our target must be to give greater information and confidence to any who have to undergo operations of any kind. We’ve made a start with heart surgery; others should follow.”

Professor Bruce Keogh, president of the Society for Cardiothoracic Surgery, added: “Our specialty has achieved what many considered unachievable. We have spectacular, internationally competitive and highly consistent results across all units in the UK, despite patients being older and sicker and having much more complex operations than ever before.”

As well as the new data for 2006, the web site also has been “cleaned up,” removing jargon and making it as user-friendly as possible.

Gamma Knife coming to Russia

Elekta (Stockholm, Sweden) reported an order to deliver a Leksell Gamma Knife 4C to a new hospital under construction in St. Petersburg, Russia, that will become the second hospital in Russia to offer non-invasive radiosurgery for tumors and other brain disorders.

The Diagnostic and Treatment Center at the International Institute of Biological Systems will open for patients in the spring of 2008 as a privately owned center of excellence for the treatment of neurological disorders.

Following the installation of the Leksell Gamma Knife, physicians at the center will be able to offer the latest technology for non-invasive brain surgery to patients in Russia and from neighboring countries.

“There are large groups of patients in Russia with brain tumors, arteriovenous malformations and other brain disorders that will benefit from our purchase of Leksell Gamma Knife, patients that otherwise had to rely on more unproven and less precise technologies for radiosurgery,” said Dr. Arkadi Stolpner, president of the Diagnostic and Treatment Center at the International Institute of Biological Systems.

He added, “With this installation we will take a huge step in increasing the treatment capacity in Russia. Stereotactic radiosurgery with Leksell Gamma Knife is an efficient and well-proven method and there is a great need for this unique technology.”

Pioneered by Elekta, stereotactic radiosurgery involves delivering a single, high dose of radiation to a small and critically located target in the brain. Gamma Knife surgery has replaced the scalpel in intracranial neurosurgery and has “dramatically widened treatment possibilities for physicians and patients,” according to Elekta.

“Gamma Knife surgery provides pinpoint accuracy, unmatched efficiency and outstanding results,” the company says. “Patients benefit from fast, painless treatment, often conducted in an outpatient surgical setting without the need for general anesthesia or even convalescence.”

To date, about 500,000 patients have undergone Gamma Knife surgery.