Final Report > Chapter 20: Understanding and Assessing the Quality of Clinical Care in Bristol > The Inquiry's independent assessment of the quality of the PCS service in Bristol > Morbidity

Morbidity

24 As well as examining rates of mortality, our Experts also examined the available statistical data on levels of morbidity following PCS in Bristol in relation to other specialist centres. Their overall conclusion was that the sources of routine data which are available do not serve as an appropriate basis for drawing any firm conclusions concerning morbidity rates in Bristol. While there was an apparently high rate of neurological complications in Bristol compared with other centres, our Experts considered it likely that there was under-recording of complications in all centres, with Bristol being slightly more full in its reporting. They also noted that the numerous sources of data in Bristol were not greatly in agreement with each other. Dr Kate Bull, one of our Experts, described some of the difficulties involved in examining morbidity following PCS, and in particular in determining the prevalence of brain damage following surgery. She drew attention to the importance of the need to conduct long-term cohort studies involving a range of disciplines, and to the relevance of the pre-operative condition of the child. She explained, further, that morbidity in the form of brain damage following children's heart surgery tended to involve a chain of causation, and that `seeking out a single cause of a complication is often not realistic'. [30] Dr Ted Sumner, one of our Experts in paediatric intensive care, was asked whether a higher incidence of post-operative morbidity could be expected in a unit with a higher incidence of mortality. He told us of studies relating to cardiac surgery in adults in the USA: `I could not find any from this country ... I think there were more than 50 centres involved in the data collection. It transpired that centres with a low mortality, good centres, had the same complication rate as centres with the higher mortality. But the difference was that the better centres, that is, centres with a lower mortality in adult cardiac surgery, had a better record of rescue of the complications, that is, they recognised them earlier and treated them better, for the same severity score.' [31]

Footnotes

[30] INQ 0049 0007 Dr Bull

[31] T81 p.83 Dr Sumner