21st July 2007

Inaugural cardiac surgery report demonstrates excellent outcomes for Prince of Wales Hospital, Hong Kong

A recent report published by the Division of Cardiac Surgery at The Chinese University of Hong Kong, which is based at the Prince of Wales Hospital, Shatin, New Territories, Hong Kong, has shown that the hospital's outcomes are better than predicted following analyses of all cardiac surgical activity. In addition, the report also states that the division's outcomes additional to mortality are 'excellent', having benchmarked postoperative morbidity against international standards.

"We believe that presentation of our outcomes in an open and 'risk-adjusted' manner has become a fundamental professional responsibility," said Professor Malcolm Underwood, Chief, Division of Cardiothoracic Surgery Department of Surgery, Prince of Wales Hospital. "We have implemented the Dendrite cardiac database system which has provided the necessary electronic record infrastructure to enable us to continuously monitor clinical outcomes. Being able to demonstrate the provision of high quality patient care will always have a high priority in our Department. The Dendrite database and analysis software is fully-integrated with our hospital clinical management system, which ensures flexibility and also opportunity to continually increase the scope of automated data collection and presentation of results."

According to the authors of this first annual report, the publication provides insights into the clinical activity in cardiac surgery, and charts progress in measuring and reporting risk-adjusted outcomes for the Division of Cardiac Surgery's patient population.

By presenting this information on an annual basis, the hospital hopes to ensure that important changes in the nature of disease treatment by cardiac surgery are observed in a timely manner, as well as assuring the community at large that its service quality and outcomes are being effectively monitored along international lines.

The 38-page report details all cardiac surgical activity between 1st November 2005 and October 31st 2006 and includes data analysis on 310 patients records. In order to ascertain how well the division was performing, the outcomes were compared and benchmarked against the National Cardiac Surgical Database report from the United Kingdom (UK).

The report was only possible to produce following the successful implementation of the Dendrite database package. This clinical management system enables the automatic uploading of patient demographic data into the cardiac database, therefore providing an audit trail, which in turn establishes the accuracy and validation of the data collected. Crucially, the clinical management system also incorporates risk stratification algorithms including Bayes and logistic regression models, which allowed clinicians at the hospital to benchmark their results against the UK's National Cardiac Surgical Database. As a result, the authors were able to verify the accuracy of the additive and logistic EuroSCORE in predicting outcomes for the patient population.

The publication shows: 

  • Risk scores suggest the hospital is operating on patients of similar risk to that of populations in the UK
  • In terms of overall activity the hospital performs fewer coronary artery bypass grafting operations and more valve operations than do comparative units in the UK
  • There are few re-operations within the hospitals cohort of patients, which is in keeping with the developing practice of a relatively new unit


Although the report acknowledges that the numbers contained within are small and low mortality mitigate against detailed risk and outcome analyses, the overall performance of the cardiac unit is stated as 'excellent' and the data collected will prove useful for future benchmarking and performance assessment, becoming yet more noteworthy as data accumulates over time.

"The first cardiac surgery report from the Division of Cardiac Surgery at the Prince of Wales Hospital clearly demonstrates the importance of clinical audit as a means of assessing surgical outcomes and ultimately, improving patient care," said Dr Peter Walton, Managing Director of Dendrite Clinical Systems. "I would like to congratulate the authors and contributors of this first report, which is a reflection of the tremendous hard work and team ethic at the hospital."