Cardiothoracic surgery

Around seven million people in England have cardiovascular disease; patients undergoing cardiothoracic surgery often have major health conditions such as heart valve disease, lung cancer and blocked arteries. The GIRFT review of cardiothoracic surgery found 28,000 cardiac surgery operations are carried out every year, and a further 69,000 thoracic operations for diseases of the organs in the chest.

Key recommendations from the 2018 national report include the need for smarter bed management and designated specialist multidisciplinary teams for key cardiothoracic surgery procedures.

GIRFT’s current clinical lead, Doug West, is a consultant thoracic surgeon at University Hospitals Bristol NHS Foundation Trust. The national report  was authored by David Richens, who has now retired from clinical practice and retired as GIRFT clinical lead in 2018.

Doug West

Clinical Lead for Cardiothoracic Surgery

Doug West has been a consultant thoracic surgeon at University Hospitals Bristol NHS Foundation Trust since 2011, where he has served as divisional audit lead and departmental clinical lead.

Doug chairs the Society for Cardiothoracic Surgery’s audit committee, and was the lead author on its 2018 National Database Report in Thoracic Surgery. He was vice chair of the 2019 NICE Lung Cancer Guideline Committee, and has worked on the development of NHS England’s National Optimal Lung Cancer Pathway and the 2019 NICE Quality Standards in Lung Cancer.

David Richens

Cardiothoracic surgery report author

The March 2018 GIRFT national report on cardiothoracic surgery was authored by David Richens. As a cardiac surgeon with a background in service development, clinical leadership and standard setting, David performed Scotland’s first heart transplant on New Year’s Day 1992. In 1995 he moved to Nottingham where he established the heart surgery unit. After working as head of service, clinical director and director of surgery, he retired from clinical practice in January 2017 and retired as GIRFT clinical lead in 2018.

Useful information

  • What kinds of procedures does cardiothoracic surgery include?
    Cardiothoracic surgery is the surgical treatment of diseases of the organs contained within the chest, including the heart, major blood vessels and the lungs. It involves major and technically demanding operations on patients who have life-threatening disease. Surgery tends to be relatively low-volume and high-cost.

  • What is the purpose of the GIRFT cardiothoracic surgery report?
    GIRFT’s report aims to support trusts and ICS’ with robust improvements to their patient flow pathways (bed management) and reducing unwarranted variation (specifically for management of clinical risk and adverse clinical outcomes, lung cancer services, aortovascular surgery, mitral valve repair). Enhanced clinical coding recording/benchmarking processes will also further support clinical development, capacity management and evaluation.

  • What data sources were used for the Cardiothoracic report?
    In addition to GIRFT visit/questionnaire data, we utilised Hospital Episode Statistics (HES), National Institute for Cardiovascular Outcome Research (NICOR) data, managed by the Healthcare Quality Improvement Partnership (HQIP) and the now defunct Public Health England (PHE) for access to the National Lung Cancer Audit (LUCADA).

GIRFT report makes 20 recommendations to improve practice, process and outcomes

Changes to the way cardiothoracic surgical services are organised and delivered in England will bring substantial benefits for patients living with conditions such as blocked arteries, lung cancer, and heart valve disease, the GIRFT report finds.

Mr David Richens, cardiothoracic surgeon and author of the report, identifies 20 recommendations to improve clinical practice, reduce unwarranted variation and patient outcomes. Data is based on in-depth clinical meetings and data reviews with the 31 cardiothoracic units in England, alongside a range of nationally verified data sources.

A key recommendation from the report is to improve patient flow and bed management systems by ensuring same-day surgery for cardiothoracic patients is delivered by default. This will help to reduce unnecessary delays and length of stay, whilst also improving the patient experience. Ring-fencing beds on intensive care units (ITU) and general wards (for cardiothoracic patients) and using less-invasive thoracic surgery procedures – such as as VATS (video-assisted thoracoscopic surgery) for lung resection surgery – are also recommended.

Find out more about GIRFT’s data-led approach and best practice resources:

In March 2018, GIRFT published its national speciality report for Cardiothoracic Surgery:

Click above to view the pdf report

Watch the video about the Cardiothoracic surgery report…

Click above to play the Cardiothoracic Surgery national report video

Cardiothoracic Surgery Academy Resources