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Christina Pagel is a researcher at Clinical Operational Research Unit, University College London, Gower Street, London, WC1E 6BT, UK


Routine monitoring of outcomes following surgery can drive service improvement and was pioneered in adult cardiac surgery. Since 2001, all cardiac procedures in children have been subject to mandatory reporting and publication in the UK. But in the rapidly developing and complex area of paediatric cardiac surgery, what are the most appropriate outcomes to measure and how should they be reported? Mortality has often been perceived as a straightforward measure of outcome and is often used to evaluate surgical performance. Currently in the UK, mortality within 30 days of heart surgery in children is monitored and published by the national audit body and each hospital’s mortality outcomes are benchmarked against recent national outcomes using the Prais risk model (1,2).
However, there are nonetheless some disadvantages to using mortality as an outcome measure (3,4). In the welcome context of falling mortality rates, morbidities following heart surgery in children are considered an ever more important outcome but they are potentially many, much more difficult to define, more difficult to measure routinely and we do not know which morbidities are the most important to track. In this talk, I will discuss the benefits and risks of monitoring mortality and an ongoing ambitious research project in the UK (5) to select, define and measure morbidities following heart surgery in children.