NHS Choices – Methodology for
clinical indicators: survival
indicators
Survival Indicators Methodology
Page 1 of 31
CONTENTS
Overview ................................................................................................................... 3
Methodology ............................................................................................................. 3
1. Data sources .................................................................................................... 3
1.1 Data period .................................................................................................... 3
2. General data processing.................................................................................... 3
2.1 Cleaning ......................................................................................................... 3
2.2 Area-level deprivation .................................................................................. 3
2.3 Trust mergers ................................................................................................ 3
3. “Intelligent” data processing .............................................................................. 4
3.1 Linkage ........................................................................................................... 4
3.2 Procedure derivation .................................................................................... 5
3.3 Outcome derivation ...................................................................................... 5
3.4 Derivation of additional parameters for risk adjustment ......................... 5
4. Risks ..................................................................................................................... 6
4.1 Denominator .................................................................................................. 6
4.2 Logistic regression models.......................................................................... 6
4.3 Estimate of risk.............................................................................................. 7
4.4 Quality of risk model (the ‘C statistic’) ....................................................... 8
5. Calculation of indicators ..................................................................................... 8
5.1 Small numbers .............................................................................................. 9
6. Future developments.......................................................................................... 9
7. Relevant publications ....................................................................................... 10
Appendix A. Trust level standardised mortality ratios ..................................... 11
Appendix B. Charlson comorbidity conditions .................................................. 30
Appendix C. Log odds for calculating risk estimates ....................................... 31
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Overview
Measures 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.
Methodology
1. Data sources
Survival 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 processing
2.1 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 mergers
As hospitals merge and services reorganised, provider codes (PROCODE) may change from
Survival Indicators Methodology
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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 processing
3.1 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
Status
Data
source
Patient
identifier used
for linkage
Orphaned
FCEs in
unfinished
spells 1
Superspells 2
1996/97 to
1999/00
Frozen
HES
SEX
+DOB
+HOMEADD
Excluded 3
Considered to be
finished
2000/01 to
2004/05
Frozen
HES
HESID
Rolled forward to
Stage 3
Considered to be
finished
Frozen
NWCS (final
extract Jan
2007)
+ Stage 2
orphans
SEX
+DOB
+HOMEADD
Rolled forward to
Stage 4
Considered to be
finished
Stage
Year of
EPIEND
1
2
3
2005/06
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4
2006/07
Frozen
SUS (Apr06
to Nov07
from Jan
2008 extract)
+ Stage 3
orphans
5
2007/08
onwards
Monthly
refresh
SUS
(Cumulative
from Apr07)
+ Stage 4
orphans
SEX
+DOB
+HOMEADD
Rolled forward to
Stage 5
Episodes in
superspells ending
in later years
unlinked and rolled
forward to Stage 5
SEX
+DOB
+HOMEADD
Excluded
Considered to be
finished
Notes: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
Hip
W37-W39, W93-W95
replacement
Knee
W40-W42
replacement
Subgroup
Subgroup coding
-
-
-
-
Suprarenal without
rupture
Repair of
abdominal
aortic
aneurysm
(AAA)
L183-6, L193-6, L203-6,
L213-6 (ICD10 primary
diagnosis is I71)
Infrarenal without
rupture
Suprarenal with
rupture
Infrarenal with
rupture
L183 (Primary
diagnosis is
I712,I714,I716,I719)
L184-6 (Primary
diagnosis is
I712,I714,I716,I719)
L183 (Primary
diagnosis is I710,
I711,I713,I715,I718)
L184-6 (Primary
diagnosis is I710,
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.
3.4 Derivation of additional parameters for risk adjustment
Table 3
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Parameter
Admission method
Definition
Excluded if invalid
If ADMIMETH = 11,12,13 in last episode of spell with valid
Yes, if no episodes in spell
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
Year of discharge
Financial year of date of discharge
have either valid DISDATE
or SPELEND=”Y” and valid
EPIEND
Deprivation quintile
Sex
Comorbidity
(Charlson score)
Derived from postcode on the episode in the spell on which the
procedure is recorded
No
Derived from the episode with the first valid value (1 or 2) of
Yes, if no episodes in spell
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
second episode. If that does not exist or has a “R” code in the
first position, we revert to the first episode.
n/a
Emergency
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.
Calculated as the number of superspells in the previous 365
admissions in
days for the same patient (using the general pseudonymised
previous 12
patient identifier). This includes the current spell, if it is an
months
emergency admission.
n/a
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/a
4. 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
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absolute number of events, so that each category contains at least 20 events. Starting from
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 modelling
Input dataset (each
specific procedure)
Create a frequency
distribution of agegroup,
Charlson, admicount12,
quintile
Frequency
distribution
Recategorise variables if
necessary (number in
each category less than
specified level)
Input dataset
recoded
Build logistic regression
model using backward
elimination procedure
Risk estimates
4.3 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.
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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
discrimination, values of 0.7-0.8 can be described as reasonable and values above 0.8
suggest good discrimination.
Table 4
Procedure
Hip replacement
Knee replacement
Repair of abdominal aortic aneurysm (AAA)
C statistic for in-hospital mortality within
30 days risk model
0.853
0.803
0.823
5. 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 subpopulations 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
Survival Indicators Methodology
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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 numbers
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
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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 model
7. Relevant publications
Bottle A, Aylin P. Intelligent Information: a national system for monitoring clinical performance.
Health Services Research 2008;43:10-31
Aylin 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: 1044
Aylin 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;33:461-465
Bottle A, Aylin P, Majeed A. Identifying patients at high risk of emergency hospital
admissions: a logistic regression analysis. JR Soc Med, Aug 2006; 99:406-414
Bottle A, Aylin P. Mortality associated with delay in operation after hip fracture: observational
study. BMJ 2006;332:947-951
Spiegelhalter 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) 1288–1294
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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 range
The 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
Trust code
RTD
RWE
RWP
Standardised
Mortality Ratio
Trust name
The Newcastle Upon Tyne Hospitals
NHS Foundation Trust
University Hospitals of Leicester NHS
Trust
Worcestershire Acute Hospitals NHS
Trust
27
0
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
REM
RTK
RF4
RVL
RNJ
RDD
RC1
RXL
Aintree University Hospitals NHS
Foundation Trust
Ashford and St Peter's Hospitals NHS
Trust
Barking, Havering and Redbridge
Hospitals NHS Trust
Barnet and Chase Farm Hospitals NHS
Trust
Barts and The London NHS Trust
Basildon and Thurrock University
Hospitals NHS Foundation Trust
Bedford Hospital NHS Trust
Blackpool Fylde and Wyre NHS
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140
277
139
105
0
104
73
97
Table 1b. Elective repair of abdominal aneurysm – within the expected
range
Standardised
Trust code
Trust name
Mortality Ratio
RMC
RXH
RXQ
RWY
RGT
RW3
RFS
RLN
RJR
RXP
RTG
RP5
RNA
RWH
RVV
RXR
RXC
RDE
RDU
RR7
RLT
RTE
RJ1
RR1
RD7
RWA
RYJ
RGQ
RNQ
RJZ
RXN
RR8
RWF
Foundation Trust
Bolton Hospitals NHS Trust
Brighton and Sussex University
Hospitals NHS Trust
Buckinghamshire Hospitals NHS Trust
Calderdale and Huddersfield NHS
Foundation Trust
Cambridge University Hospitals NHS
Foundation Trust
Central Manchester and Manchester
Children's University Hospitals NHS
Trust
Chesterfield Royal Hospital NHS
Foundation Trust
City Hospitals Sunderland NHS
Foundation Trust
Countess of Chester Hospital NHS
Foundation Trust
County Durham and Darlington NHS
Foundation Trust
Derby Hospitals NHS Foundation Trust
Doncaster and Bassetlaw Hospitals
NHS Foundation Trust
Dudley Group Of Hospitals NHS Trust
East and North Hertfordshire NHS Trust
East Kent Hospitals NHS Trust
East Lancashire Hospitals NHS Trust
East Sussex Hospitals NHS Trust
Essex Rivers Healthcare NHS Trust
Frimley Park Hospital NHS Foundation
Trust
Gateshead Health NHS Foundation
Trust
George Eliot Hospital NHS Trust
Gloucestershire Hospitals NHS
Foundation Trust
Guy's and St Thomas' NHS Foundation
Trust
Heart of England NHS Foundation Trust
Heatherwood and Wexham Park
Hospitals NHS Trust
Hull and East Yorkshire Hospitals NHS
Trust
Imperial College Healthcare NHS Trust
Ipswich Hospital NHS Trust
Kettering General Hospital NHS Trust
King's College Hospital NHS Foundation
Trust
Lancashire Teaching Hospitals NHS
Foundation Trust
Leeds Teaching Hospitals NHS Trust
Maidstone and Tunbridge Wells NHS
Trust
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257
0
137
46
46
94
32
60
143
59
108
78
84
113
90
201
0
184
103
190
43
24
60
91
146
110
73
71
101
74
328
71
227
Table 1b. Elective repair of abdominal aneurysm – within the expected
range
Standardised
Trust code
Trust name
Mortality Ratio
RPA
RQ8
RJD
RXF
RM1
RVJ
RWW
RNL
RV8
RNS
RBZ
RJL
RX1
RTH
RW6
RGN
RK9
RHU
RHW
REF
RH8
RAL
RQ6
RA2
RD1
RPR
RNZ
RXK
RHQ
RXW
RA9
RTR
RHM
RAJ
RVY
RJ7
Medway NHS Foundation Trust
Mid Essex Hospital Services NHS Trust
Mid Staffordshire General Hospitals
NHS Trust
Mid Yorkshire Hospitals NHS Trust
Norfolk and Norwich University Hospital
NHS Trust
North Bristol NHS Trust
North Cheshire Hospitals NHS Trust
North Cumbria Acute Hospitals NHS
Trust
North West London Hospitals NHS
Trust
Northampton General Hospital NHS
Trust
Northern Devon Healthcare NHS Trust
Northern Lincolnshire and Goole
Hospitals NHS Foundation Trust
Nottingham University Hospitals NHS
Trust
Oxford Radcliffe Hospitals NHS Trust
Pennine Acute Hospitals NHS Trust
Peterborough and Stamford Hospitals
NHS Foundation Trust
Plymouth Hospitals NHS Trust
Portsmouth Hospitals NHS Trust
Royal Berkshire NHS Foundation Trust
Royal Cornwall Hospitals NHS Trust
Royal Devon and Exeter NHS
Foundation Trust
Royal Free Hampstead NHS Trust
Royal Liverpool and Broadgreen
University Hospitals NHS Trust
Royal Surrey County Hospital NHS
Trust
Royal United Hospital Bath NHS Trust
Royal West Sussex NHS Trust
Salisbury NHS Foundation Trust
Sandwell and West Birmingham
Hospitals NHS Trust
Sheffield Teaching Hospitals NHS
Foundation Trust
Shrewsbury and Telford Hospital NHS
Trust
South Devon Healthcare NHS
Foundation Trust
South Tees Hospitals NHS Trust
Southampton University Hospitals NHS
Trust
Southend University Hospital NHS
Foundation Trust
Southport and Ormskirk Hospital NHS
Trust
St George's Healthcare NHS Trust
Survival Indicators Methodology
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154
80
124
180
49
49
172
0
42
315
0
0
176
95
143
332
167
105
96
87
0
43
44
50
183
113
46
66
81
74
39
68
60
123
111
103
Table 1b. Elective repair of abdominal aneurysm – within the expected
range
Standardised
Trust code
Trust name
Mortality Ratio
RBA
RAS
RJ2
RBT
RQW
RCX
RDZ
RL4
RA7
RWD
RRK
RJE
RM2
RKB
RTX
RBK
RBD
RWG
RGC
RN1
RBL
RRF
RCB
Taunton and Somerset NHS Foundation
Trust
The Hillingdon Hospital NHS Trust
The Lewisham Hospital NHS Trust
The Mid-Cheshire NHS Foundation
Trust
The Princess Alexandra Hospital NHS
Trust
The Queen Elizabeth Hospital King's
Lynn NHS Trust
The Royal Bournemouth and
Christchurch Hospitals NHS Foundation
Trust
The Royal Wolverhampton Hospitals
NHS Trust
United Bristol Healthcare NHS Trust
United Lincolnshire Hospitals NHS Trust
University Hospital Birmingham NHS
Foundation Trust
University Hospital of North
Staffordshire NHS Trust
University Hospital of South Manchester
NHS Foundation Trust
University Hospitals Coventry and
Warwickshire NHS Trust
University Hospitals Of Morecambe Bay
NHS Trust
Walsall Hospitals NHS Trust
West Dorset General Hospitals NHS
Trust
West Hertfordshire Hospitals NHS Trust
Whipps Cross University Hospital NHS
Trust
Winchester and Eastleigh Healthcare
NHS Trust
Wirral Hospital NHS Trust
Wrightington, Wigan and Leigh NHS
Trust
York Hospitals NHS Foundation Trust
82
63
86
0
93
152
80
0
84
372
125
41
93
217
116
103
53
173
0
0
216
138
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 Trust
RQQ
Hinchingbrooke Health Care NHS Trust
Survival Indicators Methodology
Page 14 of 31
Table 1c. Elective repair of abdominal aortic aneurysm: a comparable survival
rate could not be calculated
Trust code
Trust name
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 Trust
2. 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
Mortality ratio
Trust code
Trust name
RM1
Norfolk and Norwich University Hospital
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
REM
RTK
RF4
RVL
RNJ
RDD
RC1
RXL
RMC
RAE
RXH
RXQ
Aintree University Hospitals NHS
Foundation Trust
Ashford and St Peter's Hospitals NHS
Trust
Barking, Havering and Redbridge
Hospitals NHS Trust
Barnet and Chase Farm Hospitals NHS
Trust
Barts and The London NHS Trust
Basildon and Thurrock University
Hospitals NHS Foundation Trust
Bedford Hospital NHS Trust
Blackpool Fylde and Wyre NHS
Foundation Trust
Bolton Hospitals NHS Trust
Bradford Teaching Hospitals NHS
Foundation Trust
Brighton and Sussex University
Hospitals NHS Trust
Buckinghamshire Hospitals NHS Trust
Survival Indicators Methodology
Page 15 of 31
115
123
144
105
151
126
163
118
86
97
99
112
Table 2b.Emergency repair of abdominal aneurysm: “within the expected
range”
Standardised mortality
Trust code Trust name
ratio
RWY
RGT
RW3
RFS
RLN
RJR
RXP
RTG
RP5
RNA
RWH
RVV
RXR
RXC
RVR
RDE
RDU
RR7
RTE
RJ1
RCD
RR1
RD7
RWA
RYJ
RGQ
RGP
RNQ
RJZ
RXN
RR8
RWF
RPA
Calderdale and Huddersfield NHS
Foundation Trust
Cambridge University Hospitals NHS
Foundation Trust
Central Manchester and Manchester
Children's University Hospitals NHS
Trust
Chesterfield Royal Hospital NHS
Foundation Trust
City Hospitals Sunderland NHS
Foundation Trust
Countess of Chester Hospital NHS
Foundation Trust
County Durham and Darlington NHS
Foundation Trust
Derby Hospitals NHS Foundation Trust
Doncaster and Bassetlaw Hospitals
NHS Foundation Trust
Dudley Group Of Hospitals NHS Trust
East and North Hertfordshire NHS Trust
East Kent Hospitals NHS Trust
East Lancashire Hospitals NHS Trust
East Sussex Hospitals NHS Trust
Epsom and St Helier University
Hospitals NHS Trust
Essex Rivers Healthcare NHS Trust
Frimley Park Hospital NHS Foundation
Trust
Gateshead Health NHS Foundation
Trust
Gloucestershire Hospitals NHS
Foundation Trust
Guy's and St Thomas' NHS Foundation
Trust
Harrogate and District NHS Foundation
Trust
Heart of England NHS Foundation Trust
Heatherwood and Wexham Park
Hospitals NHS Trust
Hull and East Yorkshire Hospitals NHS
Trust
Imperial College Healthcare NHS Trust
Ipswich Hospital NHS Trust
James Paget University Hospitals NHS
Foundation Trust
Kettering General Hospital NHS Trust
King's College Hospital NHS Foundation
Trust
Lancashire Teaching Hospitals NHS
Foundation Trust
Leeds Teaching Hospitals NHS Trust
Maidstone and Tunbridge Wells NHS
Trust
Medway NHS Foundation Trust
Survival Indicators Methodology
Page 16 of 31
162
57
119
86
124
103
87
91
69
98
128
62
109
107
68
117
73
100
105
54
101
117
97
89
61
62
118
160
40
151
91
60
138
Table 2b.Emergency repair of abdominal aneurysm: “within the expected
range”
Standardised mortality
Trust code Trust name
ratio
RQ8
RJD
RXF
RD8
RVJ
RWW
RNL
RV8
RNS
RBZ
RJL
RX1
RTH
RW6
RGN
RK9
RHU
RHW
REF
RH8
RAL
RQ6
RA2
RD1
RPR
RNZ
RXK
RCC
RHQ
RK5
RXW
RA9
RTR
RHM
RAJ
RVY
Mid Essex Hospital Services NHS Trust
Mid Staffordshire General Hospitals
NHS Trust
Mid Yorkshire Hospitals NHS Trust
Milton Keynes General NHS Foundation
Trust
North Bristol NHS Trust
North Cheshire Hospitals NHS Trust
North Cumbria Acute Hospitals NHS
Trust
North West London Hospitals NHS Trust
Northampton General Hospital NHS
Trust
Northern Devon Healthcare NHS Trust
Northern Lincolnshire and Goole
Hospitals NHS Foundation Trust
Nottingham University Hospitals NHS
Trust
Oxford Radcliffe Hospitals NHS Trust
Pennine Acute Hospitals NHS Trust
Peterborough and Stamford Hospitals
NHS Foundation Trust
Plymouth Hospitals NHS Trust
Portsmouth Hospitals NHS Trust
Royal Berkshire NHS Foundation Trust
Royal Cornwall Hospitals NHS Trust
Royal Devon and Exeter NHS
Foundation Trust
Royal Free Hampstead NHS Trust
Royal Liverpool and Broadgreen
University Hospitals NHS Trust
Royal Surrey County Hospital NHS
Trust
Royal United Hospital Bath NHS Trust
Royal West Sussex NHS Trust
Salisbury NHS Foundation Trust
Sandwell and West Birmingham
Hospitals NHS Trust
Scarborough and North East Yorkshire
Health Care NHS Trust
Sheffield Teaching Hospitals NHS
Foundation Trust
Sherwood Forest Hospitals NHS
Foundation Trust
Shrewsbury and Telford Hospital NHS
Trust
South Devon Healthcare NHS
Foundation Trust
South Tees Hospitals NHS Trust
Southampton University Hospitals NHS
Trust
Southend University Hospital NHS
Foundation Trust
Southport and Ormskirk Hospital NHS
Survival Indicators Methodology
Page 17 of 31
79
136
123
152
94
88
131
79
119
136
279
115
95
103
106
130
87
197
96
93
105
106
145
115
89
34
118
190
108
168
90
98
104
40
103
133
Table 2b.Emergency repair of abdominal aneurysm: “within the expected
range”
Standardised mortality
Trust code Trust name
ratio
RJ7
RTP
RN3
RBA
RAS
RJ2
RBT
RTD
RQW
RCX
RDZ
RL4
RA7
RWD
RRK
RJE
RM2
RKB
RWE
RTX
RBK
RBD
RWG
RGC
RN1
RBL
RWP
RPL
RRF
RCB
Trust
St George's Healthcare NHS Trust
Surrey and Sussex Healthcare NHS
Trust
Swindon and Marlborough NHS Trust
Taunton and Somerset NHS Foundation
Trust
The Hillingdon Hospital NHS Trust
The Lewisham Hospital NHS Trust
The Mid-Cheshire NHS Foundation
Trust
The Newcastle Upon Tyne Hospitals
NHS Foundation Trust
The Princess Alexandra Hospital NHS
Trust
The Queen Elizabeth Hospital King's
Lynn NHS Trust
The Royal Bournemouth and
Christchurch Hospitals NHS Foundation
Trust
The Royal Wolverhampton Hospitals
NHS Trust
United Bristol Healthcare NHS Trust
United Lincolnshire Hospitals NHS Trust
University Hospital Birmingham NHS
Foundation Trust
University Hospital of North
Staffordshire NHS Trust
University Hospital of South Manchester
NHS Foundation Trust
University Hospitals Coventry and
Warwickshire NHS Trust
University Hospitals of Leicester NHS
Trust
University Hospitals Of Morecambe Bay
NHS Trust
Walsall Hospitals NHS Trust
West Dorset General Hospitals NHS
Trust
West Hertfordshire Hospitals NHS Trust
Whipps Cross University Hospital NHS
Trust
Winchester and Eastleigh Healthcare
NHS Trust
Wirral Hospital NHS Trust
Worcestershire Acute Hospitals NHS
Trust
Worthing and Southlands Hospitals NHS
Trust
Wrightington, Wigan and Leigh NHS
Trust
York Hospitals NHS Foundation Trust
Survival Indicators Methodology
Page 18 of 31
125
58
121
75
85
123
74
72
132
141
51
75
104
134
75
100
80
157
79
154
128
0
148
104
111
35
96
162
143
122
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 Trust
3. 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
REM
RCF
RTK
RF4
RVL
RFF
RNJ
RDD
RN5
RC1
RXL
RMC
RAE
RXH
RG3
RXQ
RJF
RWY
RGT
Aintree University Hospitals NHS
Foundation Trust
Airedale NHS Trust
Ashford and St Peter's Hospitals NHS Trust
Barking, Havering and Redbridge Hospitals
NHS Trust
Barnet and Chase Farm Hospitals NHS
Trust
Barnsley Hospital NHS Foundation Trust
Barts and The London NHS Trust
Basildon and Thurrock University Hospitals
NHS Foundation Trust
Basingstoke and North Hampshire NHS
Foundation Trust
Bedford Hospital NHS Trust
Blackpool Fylde and Wyre NHS Foundation
Trust
Bolton Hospitals NHS Trust
Bradford Teaching Hospitals NHS
Foundation Trust
Brighton and Sussex University Hospitals
NHS Trust
Bromley Hospitals NHS Trust
Buckinghamshire Hospitals NHS Trust
Burton Hospitals NHS Trust
Calderdale and Huddersfield NHS
Foundation Trust
Cambridge University Hospitals NHS
Foundation Trust
Survival Indicators Methodology
Page 19 of 31
173
0
86
189
80
103
223
105
56
74
110
339
219
130
56
144
99
117
0
Table 3a. Elective hip replacement banding: “within the expected range”
Trust code Trust name
Standardised Mortality ratio
RW3
RQM
RFS
RLN
RJR
RXP
RN7
RTG
RP5
RNA
RWH
RJN
RVV
RXR
RXC
RVR
RDE
RDU
RR7
RLT
RTE
RJ1
RCD
RR1
RD7
RLQ
RQQ
RWA
RYJ
RGQ
RGP
RNQ
RJZ
RXN
RR8
RC9
RWF
RPA
Central Manchester and Manchester
Children's University Hospitals NHS Trust
Chelsea and Westminster Hospital NHS
Foundation Trust
Chesterfield Royal Hospital NHS
Foundation Trust
City Hospitals Sunderland NHS Foundation
Trust
Countess of Chester Hospital NHS
Foundation Trust
County Durham and Darlington NHS
Foundation Trust
Dartford and Gravesham NHS Trust
Derby Hospitals NHS Foundation Trust
Doncaster and Bassetlaw Hospitals NHS
Foundation Trust
Dudley Group Of Hospitals NHS Trust
East and North Hertfordshire NHS Trust
East Cheshire NHS Trust
East Kent Hospitals NHS Trust
East Lancashire Hospitals NHS Trust
East Sussex Hospitals NHS Trust
Epsom and St Helier University Hospitals
NHS Trust
Essex Rivers Healthcare NHS Trust
Frimley Park Hospital NHS Foundation
Trust
Gateshead Health NHS Foundation Trust
George Eliot Hospital NHS Trust
Gloucestershire Hospitals NHS Foundation
Trust
Guy's and St Thomas' NHS Foundation
Trust
Harrogate and District NHS Foundation
Trust
Heart of England NHS Foundation Trust
Heatherwood and Wexham Park Hospitals
NHS Trust
Hereford Hospitals NHS Trust
Hinchingbrooke Health Care NHS Trust
Hull and East Yorkshire Hospitals NHS
Trust
Imperial College Healthcare NHS Trust
Ipswich Hospital NHS Trust
James Paget University Hospitals NHS
Foundation Trust
Kettering General Hospital NHS Trust
King's College Hospital NHS Foundation
Trust
Lancashire Teaching Hospitals NHS
Foundation Trust
Leeds Teaching Hospitals NHS Trust
Luton and Dunstable Hospital NHS
Foundation Trust
Maidstone and Tunbridge Wells NHS Trust
Medway NHS Foundation Trust
Survival Indicators Methodology
Page 20 of 31
290
152
198
208
55
87
112
93
23
62
167
77
106
0
83
43
153
129
162
163
82
37
58
107
33
111
112
216
27
50
29
52
132
107
27
52
114
179
Table 3a. Elective hip replacement banding: “within the expected range”
Trust code Trust name
Standardised Mortality ratio
RQ8
RJD
RXF
RD8
RM1
RVJ
RWW
RNL
RVW
RV8
RNS
RBZ
RJL
RTF
RX1
RBF
RW6
RGN
RK9
RHU
RG2
RL1
RHW
REF
RH8
RQ6
RAN
RA2
RD1
RPR
RM3
RNZ
RXK
RCC
RHQ
RK5
RXW
RA9
RTR
RE9
Mid Essex Hospital Services NHS Trust
Mid Staffordshire General Hospitals NHS
Trust
Mid Yorkshire Hospitals NHS Trust
Milton Keynes General NHS Foundation
Trust
Norfolk and Norwich University Hospital
NHS Trust
North Bristol NHS Trust
North Cheshire Hospitals NHS Trust
North Cumbria Acute Hospitals NHS Trust
North Tees and Hartlepool NHS Foundation
Trust
North West London Hospitals NHS Trust
Northampton General Hospital NHS Trust
Northern Devon Healthcare NHS Trust
Northern Lincolnshire and Goole Hospitals
NHS Foundation Trust
Northumbria Healthcare NHS Foundation
Trust
Nottingham University Hospitals NHS Trust
Nuffield Orthopaedic Centre NHS Trust
Pennine Acute Hospitals NHS Trust
Peterborough and Stamford Hospitals NHS
Foundation Trust
Plymouth Hospitals NHS Trust
Portsmouth Hospitals NHS Trust
Queen Elizabeth Hospital NHS Trust
Robert Jones and Agnes Hunt Orthopaedic
and District Hospital NHS Trust
Royal Berkshire NHS Foundation Trust
Royal Cornwall Hospitals NHS Trust
Royal Devon and Exeter NHS Foundation
Trust
Royal Liverpool and Broadgreen University
Hospitals NHS Trust
Royal National Orthopaedic Hospital NHS
Trust
Royal Surrey County Hospital NHS Trust
Royal United Hospital Bath NHS Trust
Royal West Sussex NHS Trust
Salford Royal NHS Foundation Trust
Salisbury NHS Foundation Trust
Sandwell and West Birmingham Hospitals
NHS Trust
Scarborough and North East Yorkshire
Health Care NHS Trust
Sheffield Teaching Hospitals NHS
Foundation Trust
Sherwood Forest Hospitals NHS
Foundation Trust
Shrewsbury and Telford Hospital NHS Trust
South Devon Healthcare NHS Foundation
Trust
South Tees Hospitals NHS Trust
South Tyneside NHS Foundation Trust
Survival Indicators Methodology
Page 21 of 31
112
0
161
179
114
45
102
127
198
42
33
128
78
192
85
67
125
24
46
119
70
72
104
68
116
39
48
152
116
142
55
132
141
0
117
77
0
152
102
0
Table 3a. Elective hip replacement banding: “within the expected range”
Trust code Trust name
Standardised Mortality ratio
RJC
RHM
RAJ
RVY
RBN
RWJ
RTP
RN3
RMP
RBA
RAS
RJ2
RBT
RTD
RQW
RCX
RFR
RDZ
RRJ
RL4
RWD
RRV
RJE
RM2
RKB
RWE
RTX
RBK
RBD
RWG
RGR
RA3
RGC
RN1
RBL
RWP
RPL
South Warwickshire General Hospitals NHS
Trust
Southampton University Hospitals NHS
Trust
Southend University Hospital NHS
Foundation Trust
Southport and Ormskirk Hospital NHS Trust
St Helens and Knowsley Hospitals NHS
Trust
Stockport NHS Foundation Trust
Surrey and Sussex Healthcare NHS Trust
Swindon and Marlborough NHS Trust
Tameside and Glossop Acute Services
NHS Trust
Taunton and Somerset NHS Foundation
Trust
The Hillingdon Hospital NHS Trust
The Lewisham Hospital NHS Trust
The Mid-Cheshire NHS Foundation Trust
The Newcastle Upon Tyne Hospitals NHS
Foundation Trust
The Princess Alexandra Hospital NHS Trust
The Queen Elizabeth Hospital King's Lynn
NHS Trust
The Rotherham NHS Foundation Trust
The Royal Bournemouth and Christchurch
Hospitals NHS Foundation Trust
The Royal Orthopaedic Hospital NHS
Foundation Trust
The Royal Wolverhampton Hospitals NHS
Trust
United Lincolnshire Hospitals NHS Trust
University College London Hospitals NHS
Foundation Trust
University Hospital of North Staffordshire
NHS Trust
University Hospital of South Manchester
NHS Foundation Trust
University Hospitals Coventry and
Warwickshire NHS Trust
University Hospitals of Leicester NHS Trust
University Hospitals Of Morecambe Bay
NHS Trust
Walsall Hospitals NHS Trust
West Dorset General Hospitals NHS Trust
West Hertfordshire Hospitals NHS Trust
West Suffolk Hospitals NHS Trust
Weston Area Health NHS Trust
Whipps Cross University Hospital NHS
Trust
Winchester and Eastleigh Healthcare NHS
Trust
Wirral Hospital NHS Trust
Worcestershire Acute Hospitals NHS Trust
Worthing and Southlands Hospitals NHS
Trust
Survival Indicators Methodology
Page 22 of 31
137
200
106
49
220
0
72
26
0
91
105
179
253
51
102
68
0
93
87
131
122
142
117
62
186
109
63
0
0
97
27
0
0
65
68
184
78
Table 3a. Elective hip replacement banding: “within the expected range”
Trust code Trust name
Standardised Mortality ratio
RRF
RA4
RCB
Wrightington, Wigan and Leigh NHS Trust
Yeovil District Hospital NHS Foundation
Trust
York Hospitals NHS Foundation Trust
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 Trust
4. 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
RVV
East Kent Hospitals NHS Trust
Standardised Mortality
ratio
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
76
Barnsley Hospital NHS
RFF
Foundation Trust
58
Survival Indicators Methodology
Page 23 of 31
46
77
93
Table 4b. Elective knee replacement: within the expected range
Standardised Mortality
Trust code
Trust name
ratio
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
135
Epsom and St Helier University
RVR
Hospitals NHS Trust
85
Survival Indicators Methodology
Page 24 of 31
Table 4b. Elective knee replacement: within the expected range
Standardised Mortality
Trust code
Trust name
ratio
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
28
RWW
North Cheshire Hospitals NHS
171
Survival Indicators Methodology
Page 25 of 31
Table 4b. Elective knee replacement: within the expected range
Standardised Mortality
Trust code
Trust name
ratio
Trust
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
Scarborough and North East
RCC
Yorkshire Health Care NHS
202
Survival Indicators Methodology
Page 26 of 31
Table 4b. Elective knee replacement: within the expected range
Standardised Mortality
Trust code
Trust name
ratio
Trust
RHQ
RK5
RXW
RA9
RTR
RE9
RJC
RHM
RAJ
RVY
RBN
RWJ
RTP
RN3
RMP
RBA
RAS
RBT
RTD
RQW
RCX
RFR
RDZ
RRJ
RL4
RM4
Sheffield Teaching Hospitals
NHS Foundation Trust
Sherwood Forest Hospitals NHS
Foundation Trust
Shrewsbury and Telford Hospital
NHS Trust
South Devon Healthcare NHS
Foundation Trust
South Tees Hospitals NHS Trust
South Tyneside NHS Foundation
Trust
South Warwickshire General
Hospitals NHS Trust
Southampton University
Hospitals NHS Trust
Southend University Hospital
NHS Foundation Trust
Southport and Ormskirk Hospital
NHS Trust
St Helens and Knowsley
Hospitals NHS Trust
Stockport NHS Foundation Trust
Surrey and Sussex Healthcare
NHS Trust
Swindon and Marlborough NHS
Trust
Tameside and Glossop Acute
Services NHS Trust
Taunton and Somerset NHS
Foundation Trust
The Hillingdon Hospital NHS
Trust
The Mid-Cheshire NHS
Foundation Trust
The Newcastle Upon Tyne
Hospitals NHS Foundation Trust
The Princess Alexandra Hospital
NHS Trust
The Queen Elizabeth Hospital
King's Lynn NHS Trust
The Rotherham NHS Foundation
Trust
The Royal Bournemouth and
Christchurch Hospitals NHS
Foundation Trust
The Royal Orthopaedic Hospital
NHS Foundation Trust
The Royal Wolverhampton
Hospitals NHS Trust
Trafford Healthcare NHS Trust
Survival Indicators Methodology
Page 27 of 31
94
253
0
199
61
0
0
93
200
0
54
41
168
150
366
118
93
0
27
160
92
145
37
103
149
366
Table 4b. Elective knee replacement: within the expected range
Standardised Mortality
Trust code
Trust name
ratio
United Lincolnshire Hospitals
RWD
NHS Trust
155
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
Survival Indicators Methodology
Page 28 of 31
Table 4c. Elective knee replacement –: a comparable survival rate could
not be calculated
Trust code
Trust name
RPC
Queen Victoria Hospital NHS Foundation Trust
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 Trust
Survival Indicators Methodology
Page 29 of 31
Appendix B. Charlson comorbidity conditions
Condition
ICD10 diagnosis codes
Acute myocardial infarction
Congestive heart failure
Peripheral vascular disease
Cerebral vascular disease
I21, I22, I252
I50
I71, I790, I739, R02, Z958, Z959
I60, I61, I62, I63, I65, I66, G450, G451, G452, G458, G459, G46,
I64, G454, I670, I671, I672, I674, I675, I676, I677, I678, I679,
I681, I682, I688, I69
F00, F01, F02, F051
J40, J41, J42, J44, J43, J45, J46, J47, J67, J44, J60, J61, J62,
J63, J66, J64, J65
M32, M34, M332, M053, M058, M059, M060, M063, M069, M050,
M052, M051, M353
K25, K26, K27, K28
K702, K703, K73, K717, K740, K742, K746, K743, K744, K745
E109, E119, E139, E149, E101, E111, E131, E141, E105, E115,
E135, E145
E102, E112, E132, E142, E103, E113, E133, E143, E104, E114,
E134, E144
G81, G041, G820, G821, G822
N03, N052, N053, N054, N055, N056, N072, N073, N074, N01,
N18, N19, N25
C0, C1, C2, C3, C40, C41, C43, C45, C46, C47, C48, C49, C5,
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, C96
1
1
1
1
C77, C78, C79, C80
K729, K766, K767, K721
B20, B21, B22, B23, B24
3
3
6
Dementia
Pulmonary disease
Connective tissue disease
Peptic ulcer disease
Liver disease
Diabetes
Diabetes with complications
Hemiplegia or paraplegia
Renal disease
Cancer
Metastatic cancer
Severe liver disease
HIV
Survival Indicators Methodology
Page 30 of 31
Score
1
1
1
1
1
1
2
2
2
2
Appendix C. Log odds for calculating risk estimates
Parameter
Log odds
Name
Value
Intercept
Admission
method
All patients
Non-elective
Elective
0
1-4
5-9
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80-84
85-89
90+
1996/97
1997/98
1998/99
1999/00
2000/01
2001/02
2002/03
2003/04
2004/05
2005/06
2006/07
Least deprived
Below average
Average
Above average
Most deprived
Unknown
Male
Female
Charlson index = 0
Charlson index = 1
Charlson index = 2
Charlson index = 3
Charlson index = 4
Charlson index = 5
Charlson index >= 6
Cannot be determined
(1996/97 only)
Zero
One
Two
Three or more
Non-palliative
Palliative
No subgroups
Suprarenal without
rupture
Infrarenal without rupture
Suprarenal with rupture
Infrarenal with rupture
Age group
Year of
discharge
Deprivation
quintile
Sex
Comorbidity
Emergency
admissions in
previous 12
months
Palliative
care
Subgroup
Survival Indicators Methodology
Hip
replacement
Knee
replacement
Repair of abdominal
aortic aneurysm
(AAA)
-1.2068
1.135
0
-3.5067
-3.5067
-3.5067
-3.5067
-3.5067
-3.5067
-3.5067
-3.5067
-3.5067
-3.5067
-3.5067
-3.4966
-3.1029
-2.9787
-2.656
-2.191
-1.5624
-1.1425
-0.6116
0
1.113
0.6505
0.7287
0.6161
0.477
0.4877
0.3912
0.4287
0.2485
0.29
0
-0.3345
-0.3353
-0.2326
-0.1268
-0.1268
0
0.3971
0
-3.5908
-2.2674
-1.511
-0.9846
-0.532
-0.6082
0
-0.143
1.3771
0
-3.4865
-3.4865
-3.4865
-3.4865
-3.4865
-3.4865
-3.4865
-3.4865
-3.4865
-3.4865
-3.4865
-3.4865
-3.4865
-3.1647
-2.9076
-2.3905
-1.7842
-1.2867
-0.6832
0
0.974
0.975
0.7413
0.6288
0.6126
0.6559
0.4924
0.4397
0.2202
0.0956
0
0
0
0
0
0
0
0.6175
0
-3.3306
-1.9559
-1.1926
-0.7193
0.1311
0.1311
0
0.6492
0.8378
0
-1.2505
-1.2505
-1.2505
-1.2505
-1.2505
-1.2505
-1.2505
-1.2505
-1.2505
-1.2505
-1.2505
-1.2505
-1.2142
-1.2122
-0.9744
-0.5917
-0.2922
-0.0208
0.3285
0
0.7236
0.5294
0.5776
0.4957
0.3758
0.349
0.3806
0.2411
0.144
0.0591
0
0.1197
0.1649
0.2443
0.3122
0.3349
0
-0.1383
0
-1.9766
-1.9766
-1.554
-1.2977
-0.7652
-0.2964
0
0
0.3056
0.3745
0.3306
0
0
0
0
0
0
0
0
0
-1.5329
0
0
0
0.0298
0.1121
0.3244
0
0
0
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
-0.8104
-1.6526
0.4383
0
Page 31 of 31