Commissioned Analysis of Surgical Performance Using Routine Data: Lessons from the Bristol Inquiry

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Abstract
Summary: The public inquiry into paediatric cardiac surgery at the Bristol Royal Infirmary commissioned the authors to design and conduct analyses of routine data sources to compare surgical outcomes between centres. Such analyses are necessarily complex in this context but were further hampered by the inherent inconsistencies and mediocre quality of the various sources of data. Three levels of analysis of increasing sophistication were carried out. The reasonable consistency of the results arising from different sources of data, together with a number of sensitivity analyses, led us to conclude that there had been excess mortality in Bristol in open heart operations on children under 1 year of age. We consider criticisms of our analysis and discuss the role of statisticians in this inquiry and their contribution to the final report of the inquiry. The potential statistical role in future programmes for monitoring clinical performance is highlighted.