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Southampton Heart Service

Cardiac experts at Spire Southampton Hospital, Hampshire

Performance, outcomes and data

  • Please click on the headings below for further information about the relevant topics. Please also see the individual profiles of our surgeons for details.

    In keeping with guidance from the NHS and Surgical Royal Colleges, all hospitals undertaking Cardiac Surgery are responsible for publishing unit and surgeon specific performance and outcome data. The information contained below is part of a report of Cardiac Surgery at Spire Southampton Hospital for the time period April 2011 to March 2014. In various graphs and charts the time periods are listed as follows for simplicity:

    2011 - 1 April 2011 to 31 March 2012

    2012 – 1 April 2012 to 31 March 2013

    2013 – 1 April 2013 to 31 March 2014

    The data reported is for all patients, both NHS and private, having heart surgery during this three year period.

    Cardiac surgical case mix at Spire Southampton Hospital 

     Graph showing cardiac surgical case mix at Spire Southampton Hospital

    Graph 1

    This graph shows Cardiac Surgical activity performed at Spire Southampton by all cardiac surgeons during the period 1 April 2011 to 31 March 2014. The graph shows the number and percentage of each type of heart surgery done at Spire Southampton Hospital. The number of operations is shown on the line going up the left hand side. The percentage (%) underneath each coloured bar shows how much of Spire Southampton’s heart surgery is made up of each procedure type.

    The key underneath the graph shows what procedure(s) each coloured bar shows. The abbreviations used are explained below:

    • Isolated: This procedure has been carried out on its own. No other procedures were done during the same operation
    • CABG: Coronary artery bypass grafting
    • AVR: Aortic valve replacement
    • MV: Mitral valve procedure (repair or replacement)
    • Other: Any procedure not in the above categories. Examples are any redo (second time) procedures, double valve procedures, major aortic surgery, cardiac tumours, pericardiectomy etc.

    This is the format used on the website ( of the Society for Cardiothoracic Surgery in Great Britain and Ireland (SCTS).

    The data shows that the case mix in Southampton is varied and complex and is in keeping with other advanced units in the United Kingdom. Fewer than 40% of cases are isolated CABGs and fewer than 20% are isolated AVRs. The percentage of combined AVR and CABGs as well as mitral procedures and all ‘Other’ surgery consequently represents 40% of the workload at Spire Southampton.

    Case Mix at Spire Southampton versus the rest of the UK

    Cardiac surgery case mix at Spire Southampton versus the rest of the UK

     Graph 2

    This graph shows the Case Mix at Spire Southampton from April 2011 to March 2014 in comparison to the average for all the hospitals in the UK from April 2010 to March 2013. It demonstrates that Spire Southampton Hospital has a case mix that is more complex than the national average. There are fewer isolated CABG procedures and consequently a greater percentage of more complex valve and ‘Other’ procedures. Please note that the most up-to-date Adult Cardiac Surgical data for the United Kingdom shown on the Society for Cardiothoracic Surgery in Great Britain and Ireland (SCTS) website ( is for the period April 2010 to March 2013 and so an absolute comparison cannot be made with the more current Spire Southampton Hospital data.

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  • Survival after heart surgery at Spire Southampton Hospital (2011 - 2014)

    Graph showing survival after heart surgery at Spire Southampton Hospital (2011 - 2014)

    Graph 3

    This graph shows the mortality rate for Spire Southampton Hospital  as the percentage of patients who die before being discharged from hospital. The data on the SCTS website shows risk adjusted mortality in order to allow comparisons between hospitals. Some hospitals do more complicated surgery on patients who are sicker, whilst others do fairly routine surgery. Comparisons can only be made if the mortality rate is ‘risk adjusted’ to take into account the difficulty of each operation and the ‘frailty score’ of the patients. The average risk adjusted mortality rate for all hospitals in the United Kingdom for the period April 2010 to March 2013 is 2.5% and this is shown as a horizontal green line in this graph. The actual, non risk-adjusted mortality rate for the period April 2011 to March 2014 at Spire Southampton Hospital is 0.8% and is shown as a blue dot. This is well beneath the UK average for the time period 2010 to 2013.

    A direct comparison of risk adjusted data cannot be made as the time periods are different and because the Spire data is the actual mortality rate and not the risk adjusted mortality. If the mortality rate was ‘risk adjusted’ it could, of course, be even lower and certainly cannot be higher than 0.8%. Data from Spire Southampton Hospital  has now been submitted to NICOR (National Institute for Cardiac Outcomes Research) for inclusion when data publication is updated on the SCTS website to the April 2011 to March 2014 time period. This will confirm the outstanding outcomes at Spire Southampton compared to the rest of the UK.

    Graph showing mortality after all operations at Spire Southampton vs UK

    Graph 4

    The SCTS website also includes a so-called "blue book on line". This gives other information about cardiac surgical activity such as how many operations are carried out in the United Kingdom each year, the actual non risk-adjusted survival outcomes of the operations, the expected outcomes of the operations, patient and surgical risk factors that are important and long-term outcomes of surgeries.

    Graph 4 shows actual in-hospital mortality at Spire Southampton Hospital after all heart operations in the three years in question and, as a comparison, actual mortality for 2010 to 2013 in the UK as a whole as published in the blue book on line. Nationally actual mortality for all cardiac surgery is over 3%, which is significantly greater than at Spire Southampton Hospital.

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  • Patient risk profile SPIRE vs UK

    Slide 1

    Slide 2

    Slide 3

    Some risk factors like age, gender, and other medical problems can affect the outcome of heart surgery. On the SCTS website graphs are shown to demonstrate what percentage of the hospital’s patients have each risk factor (orange bar on the left) next to the average for the whole of the UK (blue bar on the right). This can tell you whether the hospital generally operates on high risk patients, and whether they specialise in doing particular types of complicated surgery, like repeat operations. Again more information is available about risk factors in the "about cardiothoracic surgery" section of the SCTS website (

    The graphs on slides 1,2 and 3 show the average patient risk profile data for the period April 2011 to March 2014 for Spire Southampton Hospital. A comparison is made with the UK data for the period April 2010 to March 2013. Because the time period is different an absolute comparison cannot be made until data for the UK as a whole is updated and includes publication of Spire Southampton Hospital data. However the data does demonstrate certain important features. The percentage of patients at Spire Southampton Hospital who are over the age of 75 is significantly greater than the national average (30% versus 25%). The percentage of patients who are female is comparable to the national average of (28% versus 28%). Other risk factors shown demonstrate that a significant percentage of Spire Southampton Hospital patients have other medical problems or are undergoing complex surgery. This reinforces that Spire Southampton Hospital does not only perform straightforward surgery but achieves outstanding results despite a complex case mix and comparatively high-risk patient population.

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  • Performance by VLAD (Vertical Life Adjusted Display) plot

    EuroScore is a method of calculating predicted operative mortality for patients undergoing cardiac surgery (reference and the EuroScore calculations of an institution can be used to assess the quality of surgery and care provided there. The EuroScore establishes the risk of a patient not surviving an operation based on both patient-specific and operation-specific factors. For example, an older patient with co-existent lung and kidney disease has a higher risk than a younger patient whose only medical problem relates to his heart. In addition, a patient who is undergoing a complex operation such as a double valve procedure is at greater risk than a patient who is only undergoing a single procedure such as a CABG alone.

    Graph showing outcome data for Spire Southampton when adjusted for the logistic Euroscore, shown as a Vertical Life Adjusted Display

    Graph 5a

    The accompanying graph (Graph 5a) demonstrates outcome data at Spire Southampton Hospital when adjusted for the logistic EuroScore and is shown as a VLAD plot (Vertical Life Adjusted Display). These plots allow trend analysis looking at sequential operative results. For this analysis the sequential operation is plotted on the horizontal axis and the patient outcome on the vertical axis. For each occurrence of the adverse event (death in this case) the plot moves one unit lower but for a positive outcome (survival) the plot moves higher. This allows a graphic representation of outcome against time. The data is adjusted to take into account the patient’s operative risk according to the logistic EuroScore. In plotting the data a patient death is proportionally offset by the pre-operative risk and similarly a credit is earned for the survival of the patient, again with the amount being proportional to the patient risk according to 50% logistic EuroScore.

    Graph 5b

    In addition, tails of distribution, so-called ‘Rocket Tails’, are shown (Graph 5b).  For a given series of operations there may be many potential outcomes that could have occurred, each of which would give rise to different VLAD values. Given exact estimates for the probabilities of occurrence of each of these, it is feasible to colour code all these potential values for the VLAD scores according to percentile ranges. Superimposing such a display on the VLAD chart provides a useful guide for interpretation, as shown in Graph 5b. The different coloured zones shown in the graph provides a ‘temperature gradient’ against which to compare the track of a particular VLAD chart. The degree of displacement from the horizontal axis can easily be assessed in terms of how it compares with the distribution of chance outcomes. The further a VLAD plot falls below the horizontal, the more concerned one should be, particularly if it enters the more extreme zones of the temperature gradient. This graph shows risk-adjusted survival after Cardiac Surgery at Spire Southampton Hospital from April 2011 to March 2014 steadily increasing above the expected outcomes when risk adjusted for 50% logistic EuroScore.  The trend moves above the upper 1% tail after about 300 cases to finish significantly better than could be explained by what might have occurred purely by chance.

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  • Individual surgeon case mix and outcomes at Spire Southampton Hospital


    Individual Surgeon Case Mix

    There are currently five surgeons who perform Cardiac Surgery at Spire Southampton Hospital. Individual data are shown only for the four surgeons who have operated at Spire Southampton during the entire three year period in question.

    Graph 6a shows the case mix for Mr Cliff Barlow in the same format as was used in Graph 1 for the hospital as a whole. Graph 6b shows case mix data for Mr Steve Livesey, Graph 6c for Mr Sunil Ohri and Graph 6d shows data for Mr Geoff Tsang. The varying case mix demonstrated in the graphs shows the different specialist interests of the surgeons. Further information on the specialist interests of these four surgeons can be found by accessing "The Cardiac Surgeons" section of this website. Information on Mr Theo Velissaris, who joined the Spire Southampton team in 2013, can also be found. Outcome data for Mr Velissaris and Mr Marcus Haw, who operated at Spire Hospital Southampton until he departed for the USA in May 2012, are included in the overall Hospital performance data (Graphs 1 to 5) but not shown individually as they did not operate throughout the three years in question.


    Data for Individual Surgeons are shown alphabetically.

    Graph 6a - Case mix Mr Cliff Barlow Spire Southampton 2011 - 2014

    Graph 6b - Case mix Mr Steve Livesey Spire Southampton 2011 - 2014

    Graph 6c - Case mix Mr Sunil Ohri Southampton 2011 - 2014

    Graph 6d - Case mix Mr Geoff Tsang Spire Southampton 2011 - 2014

    Individual Surgeon Outcomes

    In keeping with guidance from the NHS and Surgical Royal Colleges, all hospitals undertaking Cardiac Surgery are also responsible for publishing surgeon specific outcome data. This graph shows in hospital actual mortality rates of patients undergoing heart surgery for the individual surgeons at Spire Southampton Hospital . The data shows mortality as a percentage of the number of cases performed over the three years. The green line shows the risk-adjusted national average for the period 2010 to 2013 as a comparison.


    Data for individual surgeons are again shown alphabetically.

    Graph 7a Survival data for Mr Cliff Barlow, Spire Southampton 2011 - 2014

    Graph 7b Survival data for Mr Steve Livesey, Spire Southampton 2011 - 2014

    Graph 7c Survival data for Mr Sunil Ohri, Spire Southampton 2011 - 2014

    Graph 7d Survival data for Mr Geoff Tsang, Spire Southampton 2011 - 2014

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Performance outcomes and data for the Southampton Heart Service, Hampshire

For further information about the individual cardiac surgeons, please click on their names below:

© Spire Healthcare Group plc (2016)