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The Society of Cardiothoracic Surgeons of Great Britain and Ireland (SCTS)

Wednesday, July 24, 2002

The Society of Cardiothoracic Surgeons of Great Britain and Ireland SCTS was founded in 1934 and was initially devoted to the practice of thoracic surgery, which at that time was mostly for tuberculosis. After World War II, with such pioneers as Lord Brock and Sir Thomas Holmes-Sellors, cardiac surgery was introduced and the number of cardiothoracic surgeons steadily increased. There are now 222 consultant members, divided into 44% cardiothoracic, 31% cardiac (including 20 surgeons who do some paediatric cardiac surgery), 20% thoracic and 5% paediatric only, plus about 93 trainee members. The purpose of the Society is to further the interests of all involved in cardiothoracic surgery. In this country, thoracic surgery has traditionally been associated with cardiac surgery rather than general surgery and vascular surgery has been associated with general surgery, rather than cardiac.

There is an annual meeting in March which includes a postgraduate day. In 2002 ProfessorAlain Carpentier was our Guest of Honour. The meeting was held in Bournemouth. Surgeons from overseas are always welcome.

The Society has an Executive Committee made up of 18 members, who run the Society. The teaching and appropriate training of junior surgeons is governed by the Executive Committee and the Specialist Advisory Committee for Higher Surgical Training with powers to recognise units as suitable for training, or not as the case may be. A member of the SCTS is present on every committee for the appointment of a new consultant. This helps to ensure standards and fairness. The Executive Commmittee also spends much time liaising with the Department of Health regarding the appropriate work done in units and how to tackle the huge burden of cardiac disease with limited resources.

Disciplinary matters arise from time to time and together with the Royal College of Surgeons, there is a rapid response mechanism, where two consultants are sent to deal with disputes, so that situations can hopefully be defused before surgeons are suspended by trigger-happy administrators.

The Society has pioneered data collection in the UK, having a register of all cardiothoracic operations since 1977. Despite the cardiologists creaming off the easier cases with angioplasty and our patients getting older and sicker, the results have continued to improve. More recently a National Adult Cardiac Surgical Database Report has been produced and this now has more than 100,000 patients with risk adjusted data in it. The 1999/2000 edition was published last July. This document has led the way for data collection and presentation in this country and other specialties are beginning to follow. At the same time as units send their annual data, all surgeons submit their results for certain benchmark procedures (e.g. isolated first time CABG, lobectomy or for congenital heart surgery, seven specific operations). These results are analysed, and if any surgeon is more than two standard deviations from the mean, he is contacted, the results checked and if correct, procedures initiated to improve things.

The activities of the SCTS have been rather dominated this year by events at Bristol and the long-awaited Kennedy Report finally appeared last July. This report, which followed the inquiry into poor results for congenital heart disease in Bristol, and took 2½ years, costing £14m ($20m), has had a major effect on medical and particularly surgical practice in this country. There were 198 recommendations, many of which were sensible and have already been addressed. One of the main messages is that good data collection and audit are vital to the proper running of the Health Service, but this can only be done with adequate financing. More than 40,000 open heart operations are performed in this country each year and the results are as good as anywhere in the world. However, inevitably they are better in some hospitals than others, and recently a commercial outfit called Dr. Foster reported unit-specific results for coronary artery surgery in The London Times (19.10.01). The SCTS reported unit-specific results for all open heart surgery and first time coronary artery surgery on the SCTS website, and although the Government derived data is of doubtful quality, the results are fairly similar. It remains to be seen whether this openness will result in surgeons being reluctant to operate on the more desperate cases for fear of getting worse results and probably in due course, surgeon-specific results will be published.

The SCTS has pioneered an accreditation scheme, whereby a team visits hospitals on request to assess if quality is monitored by a robust system of measurement of risk-stratified outcomes with clear performance targets and mechanisms of dealing with underperformance, as measured against such targets. If the unit meets the required standard, they are given a certificate of approval which will hopefully help them to attract purchasers and finance. The system is voluntary, but hopefully standards will be raised in time, as units do not want to be left behind.

The Government has appreciated the need for more activity in the fields of coronary and cancer services in particular and there will be an increase in resources. However, we still lag behind some of our European neighbours, and a long way behind the USA.

A considerable amount of research is going on in our specialty, both clinical and experimental. However, as always, funding is a problem. We have scholarships for young surgeons and, as always, taking a year or so off to go across the Atlantic is a popular way to increase experience.

Despite the increasing bureaucracy and pressures to do more with less resources, cardiothoracic surgery remains an exciting and fulfilling career, and the surgeons in Great Britain and Ireland continue to flourish.

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