NHS Choices Methodology for Clinical Indicators: Survival Indicators

NHS Choices – Methodology for clinical indicators: survival indicatorsSurvival Indicators Methodology Page 1 of 33 CONTENTS Overview...... 2 Methodology...... 2 1. Data sources...... 2 1.1 Data period...... 2 2. General data processing...... 2 2.1 Cleaning...... 2 2.2 Area-level deprivation...... 2 2.3 Trust mergers...... 2 3. “Intelligent” data processing...... 2 3.1 Linkage...... 2 3.2 Procedure derivation...... 2 3.3 Outcome derivation...... 2 3.4 Derivation of additional parameters for risk adjustment...... 2 4. Risks...... 2 4.1 Denominator...... 2 4.2 Logistic regression models...... 2 4.3 Estimate of risk...... 2 4.4 Quality of risk model (the ‘C statistic’)...... 2 5. Calculation of indicators...... 2 5.1 Small numbers...... 2 6. Future developments...... 2 7. Relevant publications...... 2 Appendix A. Trust level standardised mortality ratios...... 2 Appendix B. Charlson comorbidity conditions...... 2 Appendix C. Log odds for calculating risk estimates...... 2Survival Indicators Methodology Page 2 of 33 OverviewMeasures of survival are an important measure of the quality of care provided by hospitals. Florence Nightingale was one of the first people to identify the importance of measuring survival rates and in the 1860s, she highlighted the variation in survival rates for hospitals across London. More recently, the Bristol Royal Infirmary Inquiry highlighted the importance of openness about clinical performance, and that “patients should be able to gain access to information about the relative performance of a hospital, or a particular service or consultant unit”. Today, many clinicians routinely monitor the survival rates in their services, and use them to improve care. NHS Choices is the first national government website to publish survival rates.The rates are calculated from routinely collected hospital data. The results presented for each NHS trust are derived from a calculation called a standardised mortality ratio that refers to the number of patients who died in hospital within 30 days of having a particular procedure. The calculation compares the number of deaths for a hospital with the number of deaths that we would expect for this hospital. The rates have been adjusted to take into account a range of factors that can affect the survival rates, but which are beyond the control of the individual hospital, for example, the age and sex of the patient or whether they have another medical condition. Methodology1. Data sourcesSurvival indicators are based on the analysis of 11 years of inpatient and day case records from Hospital Episode Statistics (HES) for the period 1996/97 to 2004/05, NHS-Wide Clearing Service (NWCS) for 2005/06 and Secondary Uses Service (SUS) for 2006/07. These are data that are routinely collected within the health service for administrative purposes and not specifically for clinical audit. There may be issues regarding coverage, completeness and accuracy that need to be considered when interpreting the results.1.1 Data period The indicators reflect deaths occurring within NHS trusts over a three-year period. The data will be updated monthly on a rolling three year cycle (for example, data published in June 2008 will be based on the period January 2004 – December 2007). Data is extracted for analysis through SUS by the Doctor Foster Unit at Imperial College on the 9th of each month. 2. General data processing2.1 Cleaning These data are cleaned according to established HES guidelines with one or two minor additions/modifications. More detailed information is available on request.2.2 Area-level deprivation The population-weighted quintiles of the Carstairs deprivation score calculated by 2001 Census Output Area are then added to the data by matching on the patient’s postcode. More detailed information is available on request. 2.3 Trust mergersSurvival Indicators Methodology Page 3 of 33 As hospitals merge and services reorganised, provider codes (PROCODE) may change from one year to the next. In order to track hospitals over time, the provider codes need to be unified, i.e. just one code needs to identify each trust throughout. To date, provider codes have been unified as of the trust status at June 1st 2008.3. “Intelligent” data processing3.1 Linkage The data are in the form of consultant episodes (the continuous period during which the patient is under the care of one consultant), which need to be linked into admissions (or “spells”). Records are assumed to belong to the same person if they match on date of birth, sex and postcode (DOB, SEX,HOMEADD) as the NHS number is either not available or not recorded accurately enough across the whole period for which we have data. For the period from 2000/01 to 2004/05 we have used HESID as a patient identifier. This links patients together based on either their NHS number (with other fields added) or their local patient identifier (with other fields added). A detailed algorithm on how the HESID was derived by the Department of Health is available on request from the NHS Information Centre. Only ages within the ranges 1-120 and 7001-7007 (special values to indicate age in months for children under 1 year) are considered valid. Duplicate records (those with the same combination of provider, date of birth, sex, postcode, date of admission and episode number (PROCODE, DOB, SEX, HOMEADD, EPISTART, EPIEND, EPIORDER), unfinished episodes, those with missing/invalid ADMIDATE and regular attenders (CLASSPAT=3,4) are excluded. Some spells have the same date of admission (ADMIDATE) but different dates of discharge (DISDATE). This is not valid unless the patient was discharged and readmitted on the same day: if not, the spell with the earliest DISDATE was arbitrarily taken to be the valid one. Episodes relating to the invalid spell are excluded at this stage. Remaining episodes are sorted by provider, date of birth, sex, postcode, date of admission, date of discharge and episode number (PROCODE, DOB, SEX, HOMEADD, ADMIDATE, DISDATE, EPIORDER). Episodes are not required to be in strict sequence, only in chronological order. For example, if the first one had EPIORDER=01, the second one had EPIORDER=03 and the last one of the same spell had EPIORDER=99, then the three episodes are treated just the same as if they were numbered 01, 02 and 03 (as most multi-episode spells are). However a spell must have at least one episode with EPIORDER=01 otherwise it is considered invalid and excluded. Spells with invalid length of stay (DISDATE < ADMIDATE) are also excluded.Spells ending in transfer to another NHS hospital are linked together (“superspell”), allowing for a difference between discharge from the first trust and admission to the next trust of up to two days, using ADMIMETH= 81 or DISDEST/ADMISORC values of 49-53 (which refer to NHS providers). Data come from a number of sources and episodes are linked across years according to the method described in Table 1. Episodes ending on or after 1st April 2007 are refreshed monthly on a cumulative basis.Table 1 Orphaned Patient Year of Data FCEs in Stage Status identifier used Superspells 2 EPIEND source unfinished for linkage spells 1 SEX 1996/97 to Considered to be 1 Frozen HES +DOB Excluded 3 1999/00 finished +HOMEADD 2000/01 to Rolled forward to Considered to be 2 Frozen HES HESID 2004/05 Stage 3 finished 3 2005/06 Frozen NWCS (final SEX Rolled forward to Considered to be extract Jan +DOB Stage 4 finished 2007) +HOMEADDSurvival Indicators Methodology Page 4 of 33 + Stage 2 orphans SUS (Apr06 Episodes in to Nov07 SEX superspells ending from Jan Rolled forward to 4 2006/07 Frozen +DOB in later years 2008 extract) Stage 5 +HOMEADD unlinked and rolled + Stage 3 forward to Stage 5 orphans SUS (Cumulative SEX 2007/08 Monthly Considered to be 5 from Apr07) +DOB Excluded onwards refresh finished + Stage 4 +HOMEADD orphansNotes:- 1 Spells which are missing an episode with a valid DISDATE or an episode with SPELEND=”Y” and valid EPIEND. 2 Transfers are not linked across stage boundaries except between stages 4 & 5. 3 Episodes ending in later years related to these orphans will be linked into spells which are missing a first episode. These “widows” are also excluded.3.2 Procedure derivation The 12 operation fields use OPCS codes (Office of Population Censuses and Surveys National System for Monitoring Clinical Performance 21 1990) Classification of Interventions and Procedures Version 4.4 (April 2007). Of these the first is usually the most major even if it was not the first to be performed. No grouping scheme for OPCS4 codes currently exists, and we have therefore grouped them together after taking clinical advice from a number of professional bodies (e.g., the Vascular Surgical Society). For each spell we assign the procedure based on the first non-missing procedure field (starting with episode 1, procedure 1) containing one of the OPCS4 codes in Tables 2a and 2b. Table 2a. Current Procedure OPCS4Coding Subgroup Subgroup coding Hip W37-W39, W93-W95 - - replacement Knee W40-W42 - - replacement L183 (Primary Suprarenal without diagnosis is rupture I712,I714,I716,I719) Repair of L184-6 (Primary Infrarenal without abdominal diagnosis is L183-6, L193-6, L203-6, rupture aortic I712,I714,I716,I719) L213-6 (ICD10 primary aneurysm L183 (Primary diagnosis is I71) Suprarenal with (AAA) diagnosis is I710, rupture I711,I713,I715,I718) L184-6 (Primary Infrarenal with diagnosis is I710, rupture I711,I713,I715,I718)3.3 Outcome derivation We define our death outcome when the patient dies in hospital within 30 days of the date of the procedure or date of admission if the date of procedure is missing/invalid. The spell in which death occurs (DISMETH = 4) may be post-transfer but deaths are always allocated to the trust in which the procedure occurred. Survival Indicators Methodology Page 5 of 33 3.4 Derivation of additional parameters for risk adjustment Table 3 Parameter Definition Excluded if invalid If ADMIMETH = 11,12,13 in last episode of spell with valid Yes, if no episodes in spell Admission method ADMIMETH, then “Elective” else “Non-elective” contain valid ADMIMETH Yes, if no episodes in spell Age group Age on admission in 5-year bands (<1 year,1-4,5-9,…90+) contain valid age on admission Yes, if no episodes in spell have either valid DISDATE Year of discharge Financial year of date of discharge or SPELEND=”Y” and valid EPIEND Derived from postcode on the episode in the spell on which the Deprivation quintile No procedure is recorded Derived from the episode with the first valid value (1 or 2) of Yes, if no episodes in spell Sex SEX, going backwards from the end of the spell. contain valid SEX For each spell the episode which is dominant for diagnosis is considered to be the first episode unless the first diagnosis in the first episode is a vague “R” code in which case we use the Comorbidity second episode. If that does not exist or has a “R” code in the first position, we revert to the first episode. n/a (Charlson score) The CHARLSON score for a spell is calculated as the sum of the scores for each of the conditions (see Appendix A) in the diagnosis-dominant episode (a condition can only be counted once in a spell). This score is capped at 6. Emergency Calculated as the number of superspells in the previous 365 admissions in days for the same patient (using the general pseudonymised n/a previous 12 patient identifier). This includes the current spell, if it is an months emergency admission. If any episode in the spell has treatment function code 315 or Palliative care contains Z515 in any of the diagnosis fields, then “Palliative” n/a else “Non-palliative”. Subgroup See Table 2 n/a4. Risks 4.1 Denominator We exclude day cases (spells where CLASSPAT = 2 in first episode) from our risk models and where a trust has more than one spell in a superspell, we include only the first spell. 4.2 Logistic regression models For each procedure we derive predicted probabilities for inpatient in-hospital mortality within 30 days of procedure by fitting logistic regression models using SAS V9.1. We apply SAS’s inbuilt backwards elimination procedure for variable selection, which starts with a model including all the selected explanatory variables and then automatically removes the variable with smallest F-statistic at each step until all the non-significant variables (using a cut-off of P>0.1) have been excluded.We use the variables defined in Table 2 as our predictors. We recategorise four variables – age group, deprivation, comorbidity and number of previous admissions – depending on the absolute number of events, so that each category contains at least 20 events. Starting from Survival Indicators Methodology Page 6 of 33 the first (lowest) category, we combine it with the next lowest category if it contains fewer than 20 events and continue combining until that total has been reached. We then inspect the next highest category and repeat the process as necessary. If the last category is left with fewer than 20 events then it is combined with the second last category as one group. Figure 1 shows the sequence of our approach.Figure 1 The sequence of risk modellingInput dataset (each specific procedure)Create a frequency distribution of agegroup, Charlson, admicount12, quintileFrequency distributionRecategorise variables if necessary (number in each category less than specified level)Input dataset recodedBuild logistic regression model using backward elimination procedureRisk estimates Survival Indicators Methodology Page 7 of 33 Input dataset (each specific procedure)Create a frequency distribution of agegroup, Charlson, admicount12, quintileFrequency distributionRecategorise variables if necessary (number in each category less than specified level)Input dataset recodedBuild logistic regression model using backward elimination procedureRisk estimates4.3 Estimate of risk The risk estimate (R) for each inpatient is calculated from the table of log odds produced by the risk modelling process (Appendix B) as follows: R = exp(sum(logodds)) / (1+exp(sum(logodds)))For day cases, R=0.Risk estimates for data in years after the last year included in the risk model (currently 2006/07) are calculated using the log odds value for the last year in the model.4.4 Quality of risk model (the ‘C statistic’) The success of case-mix adjustment for accurately predicting the outcome (discrimination) was evaluated using the area under the receiver operating characteristic curve (c statistic). The c statistic is the probability of assigning a greater risk of death to a randomly selected patient who died compared with a randomly selected patient who survived. A value of 0.5 suggests that the model is no better than random chance in predicting death. A value of 1.0 suggests perfect discrimination. In general, values less than 0.7 are considered to show poor Survival Indicators Methodology Page 8 of 33 discrimination, values of 0.7-0.8 can be described as reasonable and values above 0.8 suggest good discrimination.Table 4 C statistic for in-hospital mortality within Procedure 30 days risk model Hip replacement 0.853 Knee replacement 0.803 Repair of abdominal aortic aneurysm (AAA) 0.8235. Calculation of indicators The indicators are calculated are standardised mortality ratios (SMRs)The SMR is a method of comparing mortality levels in different years, or for different sub- populations in the same year, while taking account of differences in population structure. The ratio is of (observed) to (expected) deaths, multiplied conventionally by 100. Thus if mortality levels are higher in the population being studied than would be expected, the SMR will be greater than 100.For each procedure the observed deaths are the number that have occurred following the procedure (as recorded in CDS) in each NHS Trust during the specified time period.The expected number of deaths in each analysis is the sum of the estimated risks of death.Each SMR is plotted on a funnel plot. Funnel plots (a type of statistical process control charts) are a graphical method used to assess variation in the data and are used to compare different trusts over a single time period. Funnel plots are so named because they use control limits which form a ‘funnel’ around the benchmark and reflect the expected variation in the data. Each funnel plot has three lines: a centre line, drawn at the mean (the National average, RR=100)  an upper control-limit (drawn three sigma above the centre line, upper 99.8 per cent control limit – upper red line)  a lower control limit (drawn three sigma below the centre line - lower 99.8 per cent control limit)Data points falling within the control limits are consistent with random or chance variation and are said to display ‘common-cause variation’; for data points falling outside the control limits, chance is an unlikely explanation and hence they are said to display ‘special-cause variation’- that is, where performance diverges significantly from the national rate.The distinction between control limits and confidence intervals is important; although they are very similar in construction and the difference between the two is subtle. Control limits have been used because they offer hypothesis tests whereas (strictly speaking) confidence intervals do not. Control limits come from the Poisson distribution and are calculated using an exact method using visual basic routines made available by John C Pezzullo (http://statpages.org/). For further information, please read David Spiegelhalter’s informative paper “Funnel plots for comparing institutional performance”. (Stat Med 2005 Apr 30;24(8):1185-202). The Eastern Region Public Health Observatory also has a large resource of relevant information and tools available online (www.erpho.org.uk).5.1 Small numbersSurvival Indicators Methodology Page 9 of 33 In some procedures involving small numbers of procedures or deaths, we are at the limit of what can usefully be inferred from analyses generated from traditional statistical techniques. In these circumstances, one death can make a large difference to an estimated mortality rate. Statistical Process Control charts in the guise of funnel plots are becoming increasingly accepted in the analysis of healthcare performance as they take the sample size into account, but even these charts are limited in how they deal with small numbers.Funnel plots can use a variety of statistical distributions to model what is described as normal cause variation, that is, what variation in performance might be expected due to chance. The Poisson and binomial distributions are most commonly used for discrete outcomes such as death. The Poisson distribution has been proposed for risk-adjusted data presented as ratios of Observed to Expected events (e.g. as SMRs). An inverse cumulative distribution function is used to plot the control limits on funnel plots with the X axis representing the number of expected deaths and the Y axis used to plot the SMR. Because this is based on integers, any control limits generated by exact methods will appear jagged. This is particularly noticeable with small numbers of expected counts, but this is overcome by interpolating between points. There are several other issues associated with small numbers. For processes with expected numbers of deaths less than 1, there is no obvious way to calculate control limits. This is because there is no inverse function for zero, and therefore one cannot interpolate between 0 and 1. As the lower 99.8% control limits approach zero anyway, one can assume a lower bound of zero, but the upper bounds are impossible to compute. Any unit with an expected value less than 1 is marked so that it is clear that mortality cannot be assessed adequately due to either very low expected mortality or small numbers of cases, or a combination of the two.The other issue associated with small numbers is that for expected numbers of deaths between 1 and 4, although the control limits approach zero, any process with no deaths will appear to have a significantly lower mortality than expected. For expected numbers of deaths less than 5, we bound the lower control limit at zero to avoid this problem. As a possible alternative, we have examined the use of the binomial distribution, plotting control limits around the casemix-adjusted rate based on the expected number of deaths (derived from our casemix-adjustment models) as a proportion of procedures. As the expected rate varies with each unit, this cannot be plotted on a simple funnel plot. However, the control limits can be calculated for each unit. Again, this is a discrete distribution but the expected numbers are not discrete. We could interpolate between integers of expected counts to get around the problem of jagged control limits for low expected counts. However, this method is still not immune to the issue of small numbers. Although limits can be calculated for a zero number of expected deaths, when interpolated, and particularly for rare events (low mortality), trusts with fewer than 5 expected deaths and zero mortality will still be below the lower control limit. In addition, trusts with 1 procedure and 1 subsequent death will also signal as being statistically significantly high, which might not be appropriate. In addition, it is easier to derive counts from rates and cases, than when using an SMR, which could lead to 123456potential identification of patients. We therefore have not used the binomial distribution.6. Future developments In September/October 2008 these planned improvements will change the risks:- New coding definitions for both Hip replacement and Knee replacement (Table 2b.)  Source of admission and ethnicity to be included as risk-adjustment parameters  HES data for 2005/06 and 2006/07 may replace NWCS/SUS data that is currently used  SUS data for 2007/08 to be added into the risk modelSurvival Indicators Methodology Page 10 of 33 7. Relevant publications Bottle A, Aylin P. Intelligent Information: a national system for monitoring clinical performance. Health Services Research 2008;43:10-31Aylin P, Bottle A, Elliott P. Surgical mortality - Hospital episode statistics v central cardiac audit database. BMJ 2007;335:839-839. Aylin P; Bottle A. Are hospital league tables calculated correctly? A commentary. Public Health. (06 Sep 2007).Aylin P; Bottle A; Majeed A. Use of administrative data or clinical databases as predictors of risk of death in hospital: comparison of models. BMJ 2007;334: 1044Aylin P; Lees T; Baker S; Prytherch D; Ashley S. (2007) Descriptive study comparing routine hospital administrative data with the Vascular Society of Great Britain and Ireland's National Vascular Database. Eur J Vasc Endovasc Surg 2007;33:461-465Bottle A, Aylin P, Majeed A. Identifying patients at high risk of emergency hospital admissions: a logistic regression analysis. JR Soc Med, Aug 2006; 99:406-414Bottle A, Aylin P. Mortality associated with delay in operation after hip fracture: observational study. BMJ 2006;332:947-951Spiegelhalter D. Funnel plots for institutional comparison. Quality and Safety in Health Care 2002 Dec;11(4):390-1.Spiegelhalter DJ. Funnel plots for comparing institutional performance. Stat Med 2005 Apr 30;24(8):1185-202.Vijaya Sundararajan et al. New ICD-10 version of the Charlson Comorbidity Index predicted in-hospital mortality. Journal of Clinical Epidemiology 57 (2004) 1288–1294Survival Indicators Methodology Page 11 of 33 Appendix A. Trust level standardised mortality ratios The standardised mortality ratios (SMR) are presented below for each trust for: 1. Elective repair of abdominal aneurysm (tables 1a, 1b and 1c) 2. Emergency repair of abdominal aneurysm (tables 2a, 2b and 2c) 3. Elective hip replacement (tables 3a and 3b) 4. Elective knee replacement (tables 4a, 4b and 4c)For each procedure, trusts are grouped into one of four bandings, as follows:  The survival rate is within the expected range  The survival rate is better than the expected range  A comparable survival rate could not be calculated due to low numbers of operations and/or deaths  The survival rate is worse than the expected rangeThe SMRs within a given band may vary widely between trusts. It should be noted that these differences (which arise in large part because of the relatively small numbers of deaths associated with the listed procedures) do not represent a statistically significant variation in performance. The measured performance of trusts within the same band is effectively equivalent. It would therefore be inappropriate to draw conclusions about the risks to survival at individual trusts from a ranking of the SMRs within a band.1. Elective repair of abdominal aneurysm a. Trusts in the banding “Better than the expected range”Table 1a. Elective repair of abdominal aneurysm: better than the expected range Standardised Trust code Trust name Mortality Ratio The Newcastle Upon Tyne Hospitals RTD NHS Foundation Trust 27 University Hospitals of Leicester NHS RWE Trust 0 Worcestershire Acute Hospitals NHS RWP Trust 23 b.Trusts in the banding “within the expected range” Table 1b. Elective repair of abdominal aneurysm – within the expected range Standardised Trust code Trust name Mortality Ratio Aintree University Hospitals NHS REM Foundation Trust 140 Ashford and St Peter's Hospitals NHS RTK Trust 277 Barking, Havering and Redbridge RF4 Hospitals NHS Trust 139 Barnet and Chase Farm Hospitals NHS RVL Trust 105 RNJ Barts and The London NHS Trust 0 Basildon and Thurrock University RDD Hospitals NHS Foundation Trust 104 RC1 Bedford Hospital NHS Trust 73Survival Indicators Methodology Page 12 of 33 Table 1b. Elective repair of abdominal aneurysm – within the expected range Standardised Trust code Trust name Mortality Ratio Blackpool Fylde and Wyre NHS RXL Foundation Trust 97 RMC Bolton Hospitals NHS Trust 257 Brighton and Sussex University RXH Hospitals NHS Trust 0 RXQ Buckinghamshire Hospitals NHS Trust 137 Calderdale and Huddersfield NHS RWY Foundation Trust 46 Cambridge University Hospitals NHS RGT Foundation Trust 46 Central Manchester and Manchester Children's University Hospitals NHS RW3 Trust 94 Chesterfield Royal Hospital NHS RFS Foundation Trust 32 City Hospitals Sunderland NHS RLN Foundation Trust 60 Countess of Chester Hospital NHS RJR Foundation Trust 143 County Durham and Darlington NHS RXP Foundation Trust 59 RTG Derby Hospitals NHS Foundation Trust 108 Doncaster and Bassetlaw Hospitals RP5 NHS Foundation Trust 78 RNA Dudley Group Of Hospitals NHS Trust 84 RWH East and North Hertfordshire NHS Trust 113 RVV East Kent Hospitals NHS Trust 90 RXR East Lancashire Hospitals NHS Trust 201 RXC East Sussex Hospitals NHS Trust 0 RDE Essex Rivers Healthcare NHS Trust 184 Frimley Park Hospital NHS Foundation RDU Trust 103 Gateshead Health NHS Foundation RR7 Trust 190 RLT George Eliot Hospital NHS Trust 43 Gloucestershire Hospitals NHS RTE Foundation Trust 24 Guy's and St Thomas' NHS Foundation RJ1 Trust 60 RR1 Heart of England NHS Foundation Trust 91 Heatherwood and Wexham Park RD7 Hospitals NHS Trust 146 Hull and East Yorkshire Hospitals NHS RWA Trust 110 RYJ Imperial College Healthcare NHS Trust 73RGQ Ipswich Hospital NHS Trust 71 RNQ Kettering General Hospital NHS Trust 101 King's College Hospital NHS Foundation RJZ Trust 74 Lancashire Teaching Hospitals NHS RXN Foundation Trust 328 RR8 Leeds Teaching Hospitals NHS Trust 71 RWF Maidstone and Tunbridge Wells NHS 227Survival Indicators Methodology Page 13 of 33 Table 1b. Elective repair of abdominal aneurysm – within the expected range Standardised Trust code Trust name Mortality Ratio Trust RPA Medway NHS Foundation Trust 154 RQ8 Mid Essex Hospital Services NHS Trust 80 Mid Staffordshire General Hospitals RJD NHS Trust 124 RXF Mid Yorkshire Hospitals NHS Trust 180 Norfolk and Norwich University Hospital RM1 NHS Trust 49 RVJ North Bristol NHS Trust 49 RWW North Cheshire Hospitals NHS Trust 172 North Cumbria Acute Hospitals NHS RNL Trust 0 North West London Hospitals NHS RV8 Trust 42 Northampton General Hospital NHS RNS Trust 315 RBZ Northern Devon Healthcare NHS Trust 0 Northern Lincolnshire and Goole RJL Hospitals NHS Foundation Trust 0 Nottingham University Hospitals NHS RX1 Trust 176 RTH Oxford Radcliffe Hospitals NHS Trust 95 RW6 Pennine Acute Hospitals NHS Trust 143 Peterborough and Stamford Hospitals RGN NHS Foundation Trust 332 RK9 Plymouth Hospitals NHS Trust 167 RHU Portsmouth Hospitals NHS Trust 105 RHW Royal Berkshire NHS Foundation Trust 96 REF Royal Cornwall Hospitals NHS Trust 87 Royal Devon and Exeter NHS RH8 Foundation Trust 0 RAL Royal Free Hampstead NHS Trust 43 Royal Liverpool and Broadgreen RQ6 University Hospitals NHS Trust 44 Royal Surrey County Hospital NHS RA2 Trust 50 RD1 Royal United Hospital Bath NHS Trust 183 RPR Royal West Sussex NHS Trust 113 RNZ Salisbury NHS Foundation Trust 46 Sandwell and West Birmingham RXK Hospitals NHS Trust 66 Sheffield Teaching Hospitals NHS RHQ Foundation Trust 81 Shrewsbury and Telford Hospital NHS RXW Trust 74 South Devon Healthcare NHS RA9 Foundation Trust 39 RTR South Tees Hospitals NHS Trust 68 Southampton University Hospitals NHS RHM Trust 60 Southend University Hospital NHS RAJ Foundation Trust 123 Southport and Ormskirk Hospital NHS RVY Trust 111Survival Indicators Methodology Page 14 of 33 Table 1b. Elective repair of abdominal aneurysm – within the expected range Standardised Trust code Trust name Mortality Ratio RJ7 St George's Healthcare NHS Trust 103 Taunton and Somerset NHS Foundation RBA Trust 82 RAS The Hillingdon Hospital NHS Trust 63 RJ2 The Lewisham Hospital NHS Trust 86 The Mid-Cheshire NHS Foundation RBT Trust 0 The Princess Alexandra Hospital NHS RQW Trust 93 The Queen Elizabeth Hospital King's RCX Lynn NHS Trust 152 The Royal Bournemouth and Christchurch Hospitals NHS Foundation RDZ Trust 80 The Royal Wolverhampton Hospitals RL4 NHS Trust 0 RA7 United Bristol Healthcare NHS Trust 84 RWD United Lincolnshire Hospitals NHS Trust 372 University Hospital Birmingham NHS RRK Foundation Trust 125 University Hospital of North RJE Staffordshire NHS Trust 41 University Hospital of South Manchester RM2 NHS Foundation Trust 93 University Hospitals Coventry and RKB Warwickshire NHS Trust 217 University Hospitals Of Morecambe Bay RTX NHS Trust 116 RBK Walsall Hospitals NHS Trust 103 West Dorset General Hospitals NHS RBD Trust 53 RWG West Hertfordshire Hospitals NHS Trust 173 Whipps Cross University Hospital NHS RGC Trust 0 Winchester and Eastleigh Healthcare RN1 NHS Trust 0 RBL Wirral Hospital NHS Trust 216 Wrightington, Wigan and Leigh NHS RRF Trust 138 RCB York Hospitals NHS Foundation Trust 155 c. Trusts in the banding “A comparable survival rate could not be calculated due to low numbers of operations and/or deaths”Table 1c. Elective repair of abdominal aortic aneurysm: a comparable survival rate could not be calculated Trust code Trust name RN5 Basingstoke and North Hampshire NHS Foundation Trust RAE Bradford Teaching Hospitals NHS Foundation Trust RN7 Dartford and Gravesham NHS Trust RC3 Ealing Hospital NHS Trust RVR Epsom and St Helier University Hospitals NHS Trust RCD Harrogate and District NHS Foundation TrustSurvival Indicators Methodology Page 15 of 33 Table 1c. Elective repair of abdominal aortic aneurysm: a comparable survival rate could not be calculated Trust code Trust name RQQ Hinchingbrooke Health Care NHS Trust RAX Kingston Hospital NHS Trust RJ6 Mayday Healthcare NHS Trust RD8 Milton Keynes General NHS Foundation Trust RCC Scarborough and North East Yorkshire Health Care NHS Trust RK5 Sherwood Forest Hospitals NHS Foundation Trust RJC South Warwickshire General Hospitals NHS Trust RTP Surrey and Sussex Healthcare NHS Trust RN3 Swindon and Marlborough NHS Trust RMP Tameside and Glossop Acute Services NHS Trust RBQ The Cardiothoracic Centre - Liverpool NHS Trust RRV University College London Hospitals NHS Foundation Trust RFW West Middlesex University Hospital NHS Trust RPL Worthing and Southlands Hospitals NHS Trust RA4 Yeovil District Hospital NHS Foundation Trust2. Emergency repair of abdominal aneurysm a. Trusts in the banding “better than the expected range”Table 2a. Emergency repair of abdominal aneurysm: “better than the expected range” Standardised Trust code Trust name Mortality ratio Norfolk and Norwich University Hospital RM1 NHS Trust 57 b.Trusts in banding “within the expected range”Table 2b.Emergency repair of abdominal aneurysm: “within the expected range” Standardised mortality Trust code Trust name ratio Aintree University Hospitals NHS REM Foundation Trust 115 Ashford and St Peter's Hospitals NHS RTK Trust 123 Barking, Havering and Redbridge RF4 Hospitals NHS Trust 144 Barnet and Chase Farm Hospitals NHS RVL Trust 105 RNJ Barts and The London NHS Trust 151 Basildon and Thurrock University RDD Hospitals NHS Foundation Trust 126 RC1 Bedford Hospital NHS Trust 163 Blackpool Fylde and Wyre NHS RXL Foundation Trust 118 RMC Bolton Hospitals NHS Trust 86 Bradford Teaching Hospitals NHS RAE Foundation Trust 97 Brighton and Sussex University RXH Hospitals NHS Trust 99Survival Indicators Methodology Page 16 of 33 Table 2b.Emergency repair of abdominal aneurysm: “within the expected range” Standardised mortality Trust code Trust name ratio RXQ Buckinghamshire Hospitals NHS Trust 112 Calderdale and Huddersfield NHS RWY Foundation Trust 162 Cambridge University Hospitals NHS RGT Foundation Trust 57 Central Manchester and Manchester Children's University Hospitals NHS RW3 Trust 119 Chesterfield Royal Hospital NHS RFS Foundation Trust 86 City Hospitals Sunderland NHS RLN Foundation Trust 124 Countess of Chester Hospital NHS RJR Foundation Trust 103 County Durham and Darlington NHS RXP Foundation Trust 87 RTG Derby Hospitals NHS Foundation Trust 91 Doncaster and Bassetlaw Hospitals RP5 NHS Foundation Trust 69 RNA Dudley Group Of Hospitals NHS Trust 98 RWH East and North Hertfordshire NHS Trust 128 RVV East Kent Hospitals NHS Trust 62 RXR East Lancashire Hospitals NHS Trust 109 RXC East Sussex Hospitals NHS Trust 107 Epsom and St Helier University RVR Hospitals NHS Trust 68 RDE Essex Rivers Healthcare NHS Trust 117 Frimley Park Hospital NHS Foundation RDU Trust 73 Gateshead Health NHS Foundation RR7 Trust 100 Gloucestershire Hospitals NHS RTE Foundation Trust 105 Guy's and St Thomas' NHS Foundation RJ1 Trust 54 Harrogate and District NHS Foundation RCD Trust 101 RR1 Heart of England NHS Foundation Trust 117 Heatherwood and Wexham Park RD7 Hospitals NHS Trust 97 Hull and East Yorkshire Hospitals NHS RWA Trust 89 RYJ Imperial College Healthcare NHS Trust 61 RGQ Ipswich Hospital NHS Trust 62 James Paget University Hospitals NHS RGP Foundation Trust 118 RNQ Kettering General Hospital NHS Trust 160 King's College Hospital NHS Foundation RJZ Trust 40 Lancashire Teaching Hospitals NHS RXN Foundation Trust 151 RR8 Leeds Teaching Hospitals NHS Trust 91 Maidstone and Tunbridge Wells NHS RWF Trust 60Survival Indicators Methodology Page 17 of 33 Table 2b.Emergency repair of abdominal aneurysm: “within the expected range” Standardised mortality Trust code Trust name ratio RPA Medway NHS Foundation Trust 138 RQ8 Mid Essex Hospital Services NHS Trust 79 Mid Staffordshire General Hospitals RJD NHS Trust 136 RXF Mid Yorkshire Hospitals NHS Trust 123 Milton Keynes General NHS Foundation RD8 Trust 152 RVJ North Bristol NHS Trust 94 RWW North Cheshire Hospitals NHS Trust 88 North Cumbria Acute Hospitals NHS RNL Trust 131 RV8 North West London Hospitals NHS Trust 79 Northampton General Hospital NHS RNS Trust 119 RBZ Northern Devon Healthcare NHS Trust 136 Northern Lincolnshire and Goole RJL Hospitals NHS Foundation Trust 279 Nottingham University Hospitals NHS RX1 Trust 115 RTH Oxford Radcliffe Hospitals NHS Trust 95 RW6 Pennine Acute Hospitals NHS Trust 103 Peterborough and Stamford Hospitals RGN NHS Foundation Trust 106 RK9 Plymouth Hospitals NHS Trust 130 RHU Portsmouth Hospitals NHS Trust 87 RHW Royal Berkshire NHS Foundation Trust 197 REF Royal Cornwall Hospitals NHS Trust 96 Royal Devon and Exeter NHS RH8 Foundation Trust 93 RAL Royal Free Hampstead NHS Trust 105 Royal Liverpool and Broadgreen RQ6 University Hospitals NHS Trust 106 Royal Surrey County Hospital NHS RA2 Trust 145 RD1 Royal United Hospital Bath NHS Trust 115 RPR Royal West Sussex NHS Trust 89 RNZ Salisbury NHS Foundation Trust 34 Sandwell and West Birmingham RXK Hospitals NHS Trust 118 Scarborough and North East Yorkshire RCC Health Care NHS Trust 190 Sheffield Teaching Hospitals NHS RHQ Foundation Trust 108 Sherwood Forest Hospitals NHS RK5 Foundation Trust 168 Shrewsbury and Telford Hospital NHS RXW Trust 90 South Devon Healthcare NHS RA9 Foundation Trust 98 RTR South Tees Hospitals NHS Trust 104 Southampton University Hospitals NHS RHM Trust 40 Southend University Hospital NHS RAJ Foundation Trust 103Survival Indicators Methodology Page 18 of 33 Table 2b.Emergency repair of abdominal aneurysm: “within the expected range” Standardised mortality Trust code Trust name ratio Southport and Ormskirk Hospital NHS RVY Trust 133 RJ7 St George's Healthcare NHS Trust 125 Surrey and Sussex Healthcare NHS RTP Trust 58 RN3 Swindon and Marlborough NHS Trust 121 Taunton and Somerset NHS Foundation RBA Trust 75 RAS The Hillingdon Hospital NHS Trust 85 RJ2 The Lewisham Hospital NHS Trust 123 The Mid-Cheshire NHS Foundation RBT Trust 74 The Newcastle Upon Tyne Hospitals RTD NHS Foundation Trust 72 The Princess Alexandra Hospital NHS RQW Trust 132 The Queen Elizabeth Hospital King's RCX Lynn NHS Trust 141 The Royal Bournemouth and Christchurch Hospitals NHS Foundation RDZ Trust 51 The Royal Wolverhampton Hospitals RL4 NHS Trust 75 RA7 United Bristol Healthcare NHS Trust 104 RWD United Lincolnshire Hospitals NHS Trust 134 University Hospital Birmingham NHS RRK Foundation Trust 75 University Hospital of North RJE Staffordshire NHS Trust 100 University Hospital of South Manchester RM2 NHS Foundation Trust 80 University Hospitals Coventry and RKB Warwickshire NHS Trust 157 University Hospitals of Leicester NHS RWE Trust 79 University Hospitals Of Morecambe Bay RTX NHS Trust 154 RBK Walsall Hospitals NHS Trust 128 West Dorset General Hospitals NHS RBD Trust 0 RWG West Hertfordshire Hospitals NHS Trust 148 Whipps Cross University Hospital NHS RGC Trust 104 Winchester and Eastleigh Healthcare RN1 NHS Trust 111 RBL Wirral Hospital NHS Trust 35 Worcestershire Acute Hospitals NHS RWP Trust 96 Worthing and Southlands Hospitals NHS RPL Trust 162 Wrightington, Wigan and Leigh NHS RRF Trust 143 RCB York Hospitals NHS Foundation Trust 122Survival Indicators Methodology Page 19 of 33 c. Trusts in the banding “Unable to calculate a banding – numbers too low”Table 2c. Emergency repair of abdominal aneurysm – : a comparable survival rate could not be calculated Trust code Trust name RN5 Basingstoke and North Hampshire NHS Foundation Trust RQM Chelsea and Westminster Hospital NHS Foundation Trust RN7 Dartford and Gravesham NHS Trust RC3 Ealing Hospital NHS Trust RLT George Eliot Hospital NHS Trust RQQ Hinchingbrooke Health Care NHS Trust RAX Kingston Hospital NHS Trust RJ6 Mayday Healthcare NHS Trust RAP North Middlesex University Hospital NHS Trust RD3 Poole Hospital NHS Foundation Trust RT3 Royal Brompton and Harefield NHS Trust RMP Tameside and Glossop Acute Services NHS Trust RKE The Whittington Hospital NHS Trust RRV University College London Hospitals NHS Foundation Trust RFW West Middlesex University Hospital NHS Trust RA4 Yeovil District Hospital NHS Foundation Trust3. Elective hip replacement a. Trusts in the banding “as expected”Table 3a. Elective hip replacement banding: “within the expected range” Trust code Trust name Standardised Mortality ratio Aintree University Hospitals NHS REM Foundation Trust 173 RCF Airedale NHS Trust 0 RTK Ashford and St Peter's Hospitals NHS Trust 86 Barking, Havering and Redbridge Hospitals RF4 NHS Trust 189 Barnet and Chase Farm Hospitals NHS RVL Trust 80 RFF Barnsley Hospital NHS Foundation Trust 103 RNJ Barts and The London NHS Trust 223 Basildon and Thurrock University Hospitals RDD NHS Foundation Trust 105 Basingstoke and North Hampshire NHS RN5 Foundation Trust 56 RC1 Bedford Hospital NHS Trust 74 Blackpool Fylde and Wyre NHS Foundation RXL Trust 110 RMC Bolton Hospitals NHS Trust 339 Bradford Teaching Hospitals NHS RAE Foundation Trust 219 Brighton and Sussex University Hospitals RXH NHS Trust 130 RG3 Bromley Hospitals NHS Trust 56 RXQ Buckinghamshire Hospitals NHS Trust 144 RJF Burton Hospitals NHS Trust 99 Calderdale and Huddersfield NHS RWY Foundation Trust 117Survival Indicators Methodology Page 20 of 33 Table 3a. Elective hip replacement banding: “within the expected range” Trust code Trust name Standardised Mortality ratio Cambridge University Hospitals NHS RGT Foundation Trust 0 Central Manchester and Manchester RW3 Children's University Hospitals NHS Trust 290 Chelsea and Westminster Hospital NHS RQM Foundation Trust 152 Chesterfield Royal Hospital NHS RFS Foundation Trust 198 City Hospitals Sunderland NHS Foundation RLN Trust 208 Countess of Chester Hospital NHS RJR Foundation Trust 55 County Durham and Darlington NHS RXP Foundation Trust 87 RN7 Dartford and Gravesham NHS Trust 112 RTG Derby Hospitals NHS Foundation Trust 93 Doncaster and Bassetlaw Hospitals NHS RP5 Foundation Trust 23 RNA Dudley Group Of Hospitals NHS Trust 62 RWH East and North Hertfordshire NHS Trust 167 RJN East Cheshire NHS Trust 77 RVV East Kent Hospitals NHS Trust 106 RXR East Lancashire Hospitals NHS Trust 0 RXC East Sussex Hospitals NHS Trust 83 Epsom and St Helier University Hospitals RVR NHS Trust 43 RDE Essex Rivers Healthcare NHS Trust 153 Frimley Park Hospital NHS Foundation RDU Trust 129 RR7 Gateshead Health NHS Foundation Trust 162 RLT George Eliot Hospital NHS Trust 163 Gloucestershire Hospitals NHS Foundation RTE Trust 82 RJ1 Guy's and St Thomas' NHS Foundation 37 Trust Harrogate and District NHS Foundation RCD Trust 58 RR1 Heart of England NHS Foundation Trust 107 Heatherwood and Wexham Park Hospitals RD7 NHS Trust 33 RLQ Hereford Hospitals NHS Trust 111 RQQ Hinchingbrooke Health Care NHS Trust 112 Hull and East Yorkshire Hospitals NHS RWA Trust 216 RYJ Imperial College Healthcare NHS Trust 27 RGQ Ipswich Hospital NHS Trust 50 James Paget University Hospitals NHS RGP Foundation Trust 29 RNQ Kettering General Hospital NHS Trust 52 King's College Hospital NHS Foundation RJZ Trust 132 Lancashire Teaching Hospitals NHS RXN Foundation Trust 107 RR8 Leeds Teaching Hospitals NHS Trust 27 Luton and Dunstable Hospital NHS RC9 Foundation Trust 52Survival Indicators Methodology Page 21 of 33 Table 3a. Elective hip replacement banding: “within the expected range” Trust code Trust name Standardised Mortality ratio RWF Maidstone and Tunbridge Wells NHS Trust 114 RPA Medway NHS Foundation Trust 179 RQ8 Mid Essex Hospital Services NHS Trust 112 Mid Staffordshire General Hospitals NHS RJD Trust 0 RXF Mid Yorkshire Hospitals NHS Trust 161 Milton Keynes General NHS Foundation RD8 Trust 179 Norfolk and Norwich University Hospital RM1 NHS Trust 114 RVJ North Bristol NHS Trust 45 RWW North Cheshire Hospitals NHS Trust 102 RNL North Cumbria Acute Hospitals NHS Trust 127 North Tees and Hartlepool NHS Foundation RVW Trust 198 RV8 North West London Hospitals NHS Trust 42 RNS Northampton General Hospital NHS Trust 33 RBZ Northern Devon Healthcare NHS Trust 128 Northern Lincolnshire and Goole Hospitals RJL NHS Foundation Trust 78 Northumbria Healthcare NHS Foundation RTF Trust 192 RX1 Nottingham University Hospitals NHS Trust 85 RBF Nuffield Orthopaedic Centre NHS Trust 67 RW6 Pennine Acute Hospitals NHS Trust 125 Peterborough and Stamford Hospitals NHS RGN Foundation Trust 24 RK9 Plymouth Hospitals NHS Trust 46 RHU Portsmouth Hospitals NHS Trust 119 RG2 Queen Elizabeth Hospital NHS Trust 70 Robert Jones and Agnes Hunt Orthopaedic RL1 and District Hospital NHS Trust 72 RHW Royal Berkshire NHS Foundation Trust 104 REF Royal Cornwall Hospitals NHS Trust 68 Royal Devon and Exeter NHS Foundation RH8 Trust 116 Royal Liverpool and Broadgreen University RQ6 Hospitals NHS Trust 39 Royal National Orthopaedic Hospital NHS RAN Trust 48 RA2 Royal Surrey County Hospital NHS Trust 152 RD1 Royal United Hospital Bath NHS Trust 116 RPR Royal West Sussex NHS Trust 142 RM3 Salford Royal NHS Foundation Trust 55 RNZ Salisbury NHS Foundation Trust 132 Sandwell and West Birmingham Hospitals RXK NHS Trust 141 Scarborough and North East Yorkshire RCC Health Care NHS Trust 0 Sheffield Teaching Hospitals NHS RHQ Foundation Trust 117 Sherwood Forest Hospitals NHS RK5 Foundation Trust 77 RXW Shrewsbury and Telford Hospital NHS Trust 0 South Devon Healthcare NHS Foundation RA9 Trust 152Survival Indicators Methodology Page 22 of 33 Table 3a. Elective hip replacement banding: “within the expected range” Trust code Trust name Standardised Mortality ratio RTR South Tees Hospitals NHS Trust 102 RE9 South Tyneside NHS Foundation Trust 0 South Warwickshire General Hospitals NHS RJC Trust 137 Southampton University Hospitals NHS RHM Trust 200 Southend University Hospital NHS RAJ Foundation Trust 106 RVY Southport and Ormskirk Hospital NHS Trust 49 St Helens and Knowsley Hospitals NHS RBN Trust 220 RWJ Stockport NHS Foundation Trust 0 RTP Surrey and Sussex Healthcare NHS Trust 72 RN3 Swindon and Marlborough NHS Trust 26 Tameside and Glossop Acute Services NHS RMP Trust 0 Taunton and Somerset NHS Foundation RBA Trust 91 RAS The Hillingdon Hospital NHS Trust 105 RJ2 The Lewisham Hospital NHS Trust 179 RBT The Mid-Cheshire NHS Foundation Trust 253 The Newcastle Upon Tyne Hospitals NHS RTD Foundation Trust 51 RQW The Princess Alexandra Hospital NHS Trust 102 The Queen Elizabeth Hospital King's Lynn RCX NHS Trust 68 RFR The Rotherham NHS Foundation Trust 0 The Royal Bournemouth and Christchurch RDZ Hospitals NHS Foundation Trust 93 The Royal Orthopaedic Hospital NHS RRJ Foundation Trust 87 The Royal Wolverhampton Hospitals NHS RL4 Trust 131 RWD United Lincolnshire Hospitals NHS Trust 122 University College London Hospitals NHS RRV Foundation Trust 142 University Hospital of North Staffordshire RJE NHS Trust 117 University Hospital of South Manchester RM2 NHS Foundation Trust 62 University Hospitals Coventry and RKB Warwickshire NHS Trust 186 RWE University Hospitals of Leicester NHS Trust 109 University Hospitals Of Morecambe Bay RTX NHS Trust 63 RBK Walsall Hospitals NHS Trust 0 RBD West Dorset General Hospitals NHS Trust 0 RWG West Hertfordshire Hospitals NHS Trust 97 RGR West Suffolk Hospitals NHS Trust 27 RA3 Weston Area Health NHS Trust 0 Whipps Cross University Hospital NHS RGC Trust 0 Winchester and Eastleigh Healthcare NHS RN1 Trust 65 RBL Wirral Hospital NHS Trust 68 RWP Worcestershire Acute Hospitals NHS Trust 184Survival Indicators Methodology Page 23 of 33 Table 3a. Elective hip replacement banding: “within the expected range” Trust code Trust name Standardised Mortality ratio Worthing and Southlands Hospitals NHS RPL Trust 78 RRF Wrightington, Wigan and Leigh NHS Trust 46 Yeovil District Hospital NHS Foundation RA4 Trust 77 RCB York Hospitals NHS Foundation Trust 93 b. Trusts in the banding “Unable to calculate a banding – numbers too low”Table 3b. Elective hip replacement – : a comparable survival rate could not be calculated Trust code Trust name RC3 Ealing Hospital NHS Trust RQX Homerton University Hospital NHS Foundation Trust RAX Kingston Hospital NHS Trust RJ6 Mayday Healthcare NHS Trust RNH Newham University Hospital NHS Trust RAP North Middlesex University Hospital NHS Trust RTH Oxford Radcliffe Hospitals NHS Trust RD3 Poole Hospital NHS Foundation Trust RGZ Queen Mary's Sidcup NHS Trust RAL Royal Free Hampstead NHS Trust RBS Royal Liverpool Childrens NHS Trust RJ7 St George's Healthcare NHS Trust RKE The Whittington Hospital NHS Trust RM4 Trafford Healthcare NHS Trust RA7 United Bristol Healthcare NHS Trust RRK University Hospital Birmingham NHS Foundation Trust RFW West Middlesex University Hospital NHS Trust4. Elective Knee replacement a. Trusts in the banding “better than expected”Table 4a. Elective knee replacement: better than the expected range Trust code Trust name Standardised Mortality ratio RVV East Kent Hospitals NHS Trust 0 b.Trusts in the banding “within the expected range”Table 4b. Elective knee replacement: within the expected range Standardised Mortality Trust code Trust name ratio Aintree University Hospitals NHS REM Foundation Trust 0 Ashford and St Peter's Hospitals RTK NHS Trust 63 Barking, Havering and RF4 Redbridge Hospitals NHS Trust 98 Barnet and Chase Farm RVL Hospitals NHS Trust 76Survival Indicators Methodology Page 24 of 33 Table 4b. Elective knee replacement: within the expected range Standardised Mortality Trust code Trust name ratio Barnsley Hospital NHS RFF Foundation Trust 58 Barts and The London NHS RNJ Trust 0 Basildon and Thurrock University RDD Hospitals NHS Foundation Trust 196 Basingstoke and North Hampshire NHS Foundation RN5 Trust 66 RC1 Bedford Hospital NHS Trust 52 Blackpool Fylde and Wyre NHS RXL Foundation Trust 139 RMC Bolton Hospitals NHS Trust 239 Bradford Teaching Hospitals RAE NHS Foundation Trust 111 Brighton and Sussex University RXH Hospitals NHS Trust 106 RG3 Bromley Hospitals NHS Trust 55 Buckinghamshire Hospitals NHS RXQ Trust 175 RJF Burton Hospitals NHS Trust 105 Calderdale and Huddersfield RWY NHS Foundation Trust 132 Cambridge University Hospitals RGT NHS Foundation Trust 0 Central Manchester and Manchester Children's University RW3 Hospitals NHS Trust 0 Chesterfield Royal Hospital NHS RFS Foundation Trust 240 City Hospitals Sunderland NHS RLN Foundation Trust 189 Countess of Chester Hospital RJR NHS Foundation Trust 61 County Durham and Darlington RXP NHS Foundation Trust 52 Dartford and Gravesham NHS RN7 Trust 0 Derby Hospitals NHS Foundation RTG Trust 118 Doncaster and Bassetlaw RP5 Hospitals NHS Foundation Trust 73 Dudley Group Of Hospitals NHS RNA Trust 61 RC3 Ealing Hospital NHS Trust 239 East and North Hertfordshire RWH NHS Trust 200 RJN East Cheshire NHS Trust 46 East Lancashire Hospitals NHS RXR Trust 74 East Sussex Hospitals NHS RXC Trust 135Survival Indicators Methodology Page 25 of 33 Table 4b. Elective knee replacement: within the expected range Standardised Mortality Trust code Trust name ratio Epsom and St Helier University RVR Hospitals NHS Trust 85 Essex Rivers Healthcare NHS RDE Trust 35 Frimley Park Hospital NHS RDU Foundation Trust 86 Gateshead Health NHS RR7 Foundation Trust 0 RLT George Eliot Hospital NHS Trust 208 Gloucestershire Hospitals NHS RTE Foundation Trust 155 Guy's and St Thomas' NHS RJ1 Foundation Trust 34 Harrogate and District NHS RCD Foundation Trust 0 Heart of England NHS RR1 Foundation Trust 194 Heatherwood and Wexham Park RD7 Hospitals NHS Trust 152 RLQ Hereford Hospitals NHS Trust 105 Hinchingbrooke Health Care RQQ NHS Trust 50 Hull and East Yorkshire RWA Hospitals NHS Trust 70 Imperial College Healthcare NHS RYJ Trust 0 RGQ Ipswich Hospital NHS Trust 152 James Paget University RGP Hospitals NHS Foundation Trust 235 Kettering General Hospital NHS RNQ Trust 98 King's College Hospital NHS RJZ Foundation Trust 56 Lancashire Teaching Hospitals RXN NHS Foundation Trust 111 Leeds Teaching Hospitals NHS RR8 Trust 69 Luton and Dunstable Hospital RC9 NHS Foundation Trust 323 Maidstone and Tunbridge Wells RWF NHS Trust 30 RPA Medway NHS Foundation Trust 172 Mid Essex Hospital Services RQ8 NHS Trust 38 Mid Staffordshire General RJD Hospitals NHS Trust 88 Mid Yorkshire Hospitals NHS RXF Trust 143 Milton Keynes General NHS RD8 Foundation Trust 75 Norfolk and Norwich University RM1 Hospital NHS Trust 142 RVJ North Bristol NHS Trust 28Survival Indicators Methodology Page 26 of 33 Table 4b. Elective knee replacement: within the expected range Standardised Mortality Trust code Trust name ratio North Cheshire Hospitals NHS RWW Trust 171 North Cumbria Acute Hospitals RNL NHS Trust 136 North Tees and Hartlepool NHS RVW Foundation Trust 61 North West London Hospitals RV8 NHS Trust 38 Northampton General Hospital RNS NHS Trust 68 Northern Devon Healthcare NHS RBZ Trust 47 Northern Lincolnshire and Goole RJL Hospitals NHS Foundation Trust 79 Northumbria Healthcare NHS RTF Foundation Trust 138 Nottingham University Hospitals RX1 NHS Trust 133 Nuffield Orthopaedic Centre RBF NHS Trust 46 Pennine Acute Hospitals NHS RW6 Trust 74 Peterborough and Stamford RGN Hospitals NHS Foundation Trust 33 RK9 Plymouth Hospitals NHS Trust 126 RHU Portsmouth Hospitals NHS Trust 57 Queen Elizabeth Hospital NHS RG2 Trust 151 RGZ Queen Mary's Sidcup NHS Trust 0 Robert Jones and Agnes Hunt Orthopaedic and District Hospital RL1 NHS Trust 38 Royal Berkshire NHS Foundation RHW Trust 236 Royal Cornwall Hospitals NHS REF Trust 62 Royal Devon and Exeter NHS RH8 Foundation Trust 106 Royal Liverpool and Broadgreen RQ6 University Hospitals NHS Trust 198 Royal National Orthopaedic RAN Hospital NHS Trust 51 Royal Surrey County Hospital RA2 NHS Trust 111 Royal United Hospital Bath NHS RD1 Trust 222 RPR Royal West Sussex NHS Trust 35 Salford Royal NHS Foundation RM3 Trust 131 RNZ Salisbury NHS Foundation Trust 242 Sandwell and West Birmingham RXK Hospitals NHS Trust 141 RCC Scarborough and North East 202 Yorkshire Health Care NHS Survival Indicators Methodology Page 27 of 33 Table 4b. Elective knee replacement: within the expected range Standardised Mortality Trust code Trust name ratioTrust Sheffield Teaching Hospitals RHQ NHS Foundation Trust 94 Sherwood Forest Hospitals NHS RK5 Foundation Trust 253 Shrewsbury and Telford Hospital RXW NHS Trust 0 South Devon Healthcare NHS RA9 Foundation Trust 199 RTR South Tees Hospitals NHS Trust 61 South Tyneside NHS Foundation RE9 Trust 0 South Warwickshire General RJC Hospitals NHS Trust 0 Southampton University RHM Hospitals NHS Trust 93 Southend University Hospital RAJ NHS Foundation Trust 200 Southport and Ormskirk Hospital RVY NHS Trust 0 St Helens and Knowsley RBN Hospitals NHS Trust 54 RWJ Stockport NHS Foundation Trust 41 Surrey and Sussex Healthcare RTP NHS Trust 168 Swindon and Marlborough NHS RN3 Trust 150 Tameside and Glossop Acute RMP Services NHS Trust 366 Taunton and Somerset NHS RBA Foundation Trust 118 The Hillingdon Hospital NHS RAS Trust 93 The Mid-Cheshire NHS RBT Foundation Trust 0 The Newcastle Upon Tyne RTD Hospitals NHS Foundation Trust 27 The Princess Alexandra Hospital RQW NHS Trust 160 The Queen Elizabeth Hospital RCX King's Lynn NHS Trust 92 The Rotherham NHS Foundation RFR Trust 145 The Royal Bournemouth and Christchurch Hospitals NHS RDZ Foundation Trust 37 The Royal Orthopaedic Hospital RRJ NHS Foundation Trust 103 The Royal Wolverhampton RL4 Hospitals NHS Trust 149 RM4 Trafford Healthcare NHS Trust 366 RWD United Lincolnshire Hospitals 155Survival Indicators Methodology Page 28 of 33 Table 4b. Elective knee replacement: within the expected range Standardised Mortality Trust code Trust name ratio NHS Trust University College London RRV Hospitals NHS Foundation Trust 166 University Hospital of North RJE Staffordshire NHS Trust 0 University Hospital of South Manchester NHS Foundation RM2 Trust 73 University Hospitals Coventry RKB and Warwickshire NHS Trust 170 University Hospitals of Leicester RWE NHS Trust 36 University Hospitals Of RTX Morecambe Bay NHS Trust 50 RBK Walsall Hospitals NHS Trust 110 West Dorset General Hospitals RBD NHS Trust 63 West Hertfordshire Hospitals RWG NHS Trust 199 West Suffolk Hospitals NHS RGR Trust 79 RA3 Weston Area Health NHS Trust 31 Whipps Cross University RGC Hospital NHS Trust 134 Winchester and Eastleigh RN1 Healthcare NHS Trust 231 RBL Wirral Hospital NHS Trust 38 Worcestershire Acute Hospitals RWP NHS Trust 41 Worthing and Southlands RPL Hospitals NHS Trust 114 Wrightington, Wigan and Leigh RRF NHS Trust 38 Yeovil District Hospital NHS RA4 Foundation Trust 0 York Hospitals NHS Foundation RCB Trust 93 c. Trusts in the banding “a comparable survival rate could not be calculated due to ”Table 4c. Elective knee replacement –: a comparable survival rate could not be calculated Trust code Trust name RCF Airedale NHS Trust RQM Chelsea and Westminster Hospital NHS Foundation Trust RQX Homerton University Hospital NHS Foundation Trust RAX Kingston Hospital NHS Trust RJ6 Mayday Healthcare NHS Trust RNH Newham University Hospital NHS Trust RAP North Middlesex University Hospital NHS Trust RTH Oxford Radcliffe Hospitals NHS Trust RD3 Poole Hospital NHS Foundation Trust RPC Queen Victoria Hospital NHS Foundation TrustSurvival Indicators Methodology Page 29 of 33 Table 4c. Elective knee replacement –: a comparable survival rate could not be calculated Trust code Trust name RAL Royal Free Hampstead NHS Trust RJ7 St George's Healthcare NHS Trust RJ2 The Lewisham Hospital NHS Trust RKE The Whittington Hospital NHS Trust RRK University Hospital Birmingham NHS Foundation Trust RFW West Middlesex University Hospital NHS TrustSurvival Indicators Methodology Page 30 of 33 Appendix B. Charlson comorbidity conditions Condition ICD10 diagnosis codes Score Acute myocardial infarction I21, I22, I252 1 Congestive heart failure I50 1 Peripheral vascular disease I71, I790, I739, R02, Z958, Z959 1 Cerebral vascular disease I60, I61, I62, I63, I65, I66, G450, G451, G452, G458, G459, G46, 1 I64, G454, I670, I671, I672, I674, I675, I676, I677, I678, I679, I681, I682, I688, I69 Dementia F00, F01, F02, F051 1 Pulmonary disease J40, J41, J42, J44, J43, J45, J46, J47, J67, J44, J60, J61, J62, 1 J63, J66, J64, J65 Connective tissue disease M32, M34, M332, M053, M058, M059, M060, M063, M069, M050, 1 M052, M051, M353 Peptic ulcer disease K25, K26, K27, K28 1 Liver disease K702, K703, K73, K717, K740, K742, K746, K743, K744, K745 1 Diabetes E109, E119, E139, E149, E101, E111, E131, E141, E105, E115, 1 E135, E145 Diabetes with complications E102, E112, E132, E142, E103, E113, E133, E143, E104, E114, 2 E134, E144 Hemiplegia or paraplegia G81, G041, G820, G821, G822 2 Renal disease N03, N052, N053, N054, N055, N056, N072, N073, N074, N01, 2 N18, N19, N25 Cancer C0, C1, C2, C3, C40, C41, C43, C45, C46, C47, C48, C49, C5, 2 C6, C70, C71, C72, C73, C74, C75, C76, C81, C82, C83, C84, C85, C883, C887, C889, C900, C901, C91, C92, C93, C940, C941, C942, C943, C945, C947, C95, C96Metastatic cancer C77, C78, C79, C80 3 Severe liver disease K729, K766, K767, K721 3 HIV B20, B21, B22, B23, B24 6Survival Indicators Methodology Page 31 of 33 Appendix C. Log odds for calculating risk estimates Parameter Log odds Repair of abdominal Hip Knee aortic aneurysm Name Value replacement replacement (AAA) Intercept All patients -1.2068 -0.143 0.6492 Admission Non-elective 1.135 1.3771 0.8378 method Elective 0 0 0 0 -3.5067 -3.4865 -1.2505 1-4 -3.5067 -3.4865 -1.2505 5-9 -3.5067 -3.4865 -1.2505 10-14 -3.5067 -3.4865 -1.2505 15-19 -3.5067 -3.4865 -1.2505 20-24 -3.5067 -3.4865 -1.2505 25-29 -3.5067 -3.4865 -1.2505 30-34 -3.5067 -3.4865 -1.2505 35-39 -3.5067 -3.4865 -1.2505 40-44 -3.5067 -3.4865 -1.2505 Age group 45-49 -3.5067 -3.4865 -1.2505 50-54 -3.4966 -3.4865 -1.2505 55-59 -3.1029 -3.4865 -1.2142 60-64 -2.9787 -3.1647 -1.2122 65-69 -2.656 -2.9076 -0.9744 70-74 -2.191 -2.3905 -0.5917 75-79 -1.5624 -1.7842 -0.2922 80-84 -1.1425 -1.2867 -0.0208 85-89 -0.6116 -0.6832 0.3285 90+ 0 0 0 1996/97 1.113 0.974 0.7236 1997/98 0.6505 0.975 0.5294 1998/99 0.7287 0.7413 0.5776 1999/00 0.6161 0.6288 0.4957 2000/01 0.477 0.6126 0.3758 Year of 2001/02 0.4877 0.6559 0.349 discharge 2002/03 0.3912 0.4924 0.3806 2003/04 0.4287 0.4397 0.2411 2004/05 0.2485 0.2202 0.144 2005/06 0.29 0.0956 0.0591 2006/07 0 0 0 Least deprived -0.3345 0 0.1197 Below average -0.3353 0 0.1649 Deprivation Average -0.2326 0 0.2443 quintile Above average -0.1268 0 0.3122 Most deprived -0.1268 0 0.3349 Unknown 0 0 0 Male 0.3971 0.6175 -0.1383 Sex Female 0 0 0 Charlson index = 0 -3.5908 -3.3306 -1.9766 Charlson index = 1 -2.2674 -1.9559 -1.9766 Charlson index = 2 -1.511 -1.1926 -1.554 Comorbidity Charlson index = 3 -0.9846 -0.7193 -1.2977 Charlson index = 4 -0.532 0.1311 -0.7652 Charlson index = 5 -0.6082 0.1311 -0.2964 Charlson index >= 6 0 0 0 Cannot be determined Emergency (1996/97 only) 0 0 0 admissions in Zero 0.3056 0 0.0298 previous 12 One 0.3745 0 0.1121 months Two 0.3306 0 0.3244 Three or more 0 0 0 Palliative Non-palliative 0 -1.5329 0 care Palliative 0 0 0 No subgroups 0 0 n/a Suprarenal without rupture n/a n/a -0.8104 Subgroup Infrarenal without rupture n/a n/a -1.6526 Suprarenal with rupture n/a n/a 0.4383 Infrarenal with rupture n/a n/a 0Survival Indicators Methodology Page 32 of 33 Survival Indicators Methodology Page 33 of 33

NHS Choices Methodology for Clinical Indicators: Survival Indicators

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