Device Results

I feel that it is imperative that consultants publish their results. In time device doctors will have to publish their results in a national league table. We are not there yet nationally, but I hope we will be soon. 

 

You are aware as an operator that your work is being scrutinised and I feel it makes me a more careful operator.

 

There are clearly issues with publishing results, and a detailed discussion is beyond the scope of this post. Defining complications is surprisingly difficult. Certain patients are recognised as being at higher risk of complications. For example, patients who are at the extremes of weight (both underweight and overweight),  taking warfarin or immunosuppressants, or who are particularly frail or confused have higher rates of complications. The rate of complications is related to the complexity of the procedure. A single chamber pacemaker is less likely to go wrong than a biventricular ICD. Therefore casemix has to be adjusted for. The play of chance is also relevant. It is possible to appear to be a magnificent operator one year and a mediocre one the next; long-term trends over thousands of devices are important. 

 

At our institution we undertake "simple" (single and dual chamber conventional pacemakers) and "complex" device implants (cardiac resynchronisation therapy/biventricular pacemakers and implantable cardioverter defibrillators). We will remove devices that are less than one year old, but do not remove devices that are older (generally speaking).  I tend to do more complex procedures and also undertake a number of corrective procedures. 

 

We have already published long-term data from our institution:

 

http://bjcardio.co.uk/2012/05/pacemaker-complications-in-a-district-general-hospital/

 

We have published an abstract detailing what we have done to reduce our infection rate and the consequences:

 

http://europace.oxfordjournals.org/content/14/suppl_4/iv22.abstract?sid=ce10eb0d-3a91-4603-a073-12fdded80aff

 

Surprisingly there are few comparative data from the UK detailing outcomes. Liverpool are about to publish their data and I will link the paper to this page. 

 

If you have been operated on by myself, have had a complication, and do not see your complication listed, please let me know.