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					     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




Survival Indicators Methodology                          Page 2 of 31
    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
                                                                             th
analysis through SUS by the Doctor Foster Unit at Imperial College on the 9 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             Page 3 of 31
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
                                                          st
method described in Table 1. Episodes ending on or after 1 April 2007 are refreshed monthly
on a cumulative basis.

Table 1
                                                                  Orphaned
                                                Patient
          Year of               Data                              FCEs in                            2
Stage                  Status                   identifier used                       Superspells
          EPIEND                source                            unfinished
                                                for linkage              1
                                                                  spells
                                                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
                                NWCS (final
                                extract Jan     SEX
                                                                  Rolled forward to   Considered to be
3         2005/06      Frozen   2007)           +DOB
                                                                  Stage 4             finished
                                + Stage 2       +HOMEADD
                                orphans



Survival Indicators Methodology               Page 4 of 31
                                        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
                                        orphans


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                                 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.



3.4 Derivation of additional parameters for risk adjustment
Table 3


Survival Indicators Methodology                         Page 5 of 31
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/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



Survival Indicators Methodology                          Page 6 of 31
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.



Survival Indicators Methodology             Page 7 of 31
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
                                                   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)                              0.823




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 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



Survival Indicators Methodology             Page 8 of 31
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


Survival Indicators Methodology              Page 9 of 31
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




Survival Indicators Methodology              Page 10 of 31
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
                                                                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                                      73
RXL                 Blackpool Fylde and Wyre NHS                                    97



Survival Indicators Methodology            Page 11 of 31
Table 1b. Elective repair of abdominal aneurysm – within the expected
range
                                                        Standardised
Trust code        Trust name                            Mortality Ratio
                  Foundation Trust
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                    73

RGQ               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
                  Maidstone and Tunbridge Wells NHS
RWF               Trust                                                   227



Survival Indicators Methodology        Page 12 of 31
Table 1b. Elective repair of abdominal aneurysm – within the expected
range
                                                        Standardised
Trust code        Trust name                            Mortality Ratio
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                                                   111
RJ7               St George's Healthcare NHS Trust                        103



Survival Indicators Methodology         Page 13 of 31
Table 1b. Elective repair of abdominal aneurysm – within the expected
range
                                                        Standardised
Trust code        Trust name                            Mortality Ratio
                  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 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
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                                             99
 RXQ           Buckinghamshire Hospitals NHS Trust                            112


Survival Indicators Methodology         Page 15 of 31
 Table 2b.Emergency repair of abdominal aneurysm: “within the expected
 range”
                                                  Standardised mortality
 Trust code Trust name                                               ratio
               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                                                   60
 RPA           Medway NHS Foundation Trust                            138



Survival Indicators Methodology        Page 16 of 31
 Table 2b.Emergency repair of abdominal aneurysm: “within the expected
 range”
                                                  Standardised mortality
 Trust code Trust name                                               ratio
 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                                       103
 RVY           Southport and Ormskirk Hospital NHS                    133



Survival Indicators Methodology       Page 17 of 31
 Table 2b.Emergency repair of abdominal aneurysm: “within the expected
 range”
                                                  Standardised mortality
 Trust code Trust name                                               ratio
               Trust
 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                    122




Survival Indicators Methodology        Page 18 of 31
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
               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                                                   117
               Cambridge University Hospitals NHS
 RGT           Foundation Trust                                                     0


Survival Indicators Methodology        Page 19 of 31
 Table 3a. Elective hip replacement banding: “within the expected range”
 Trust code Trust name                                    Standardised Mortality ratio
               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
               Guy's and St Thomas' NHS Foundation
 RJ1           Trust                                                               37
               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                                                    52
 RWF           Maidstone and Tunbridge Wells NHS Trust                            114
 RPA           Medway NHS Foundation Trust                                        179



Survival Indicators Methodology        Page 20 of 31
 Table 3a. Elective hip replacement banding: “within the expected range”
 Trust code Trust name                                    Standardised Mortality ratio
 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                                                              152
 RTR           South Tees Hospitals NHS Trust                                     102
 RE9           South Tyneside NHS Foundation Trust                                  0



Survival Indicators Methodology       Page 21 of 31
 Table 3a. Elective hip replacement banding: “within the expected range”
 Trust code Trust name                                    Standardised Mortality ratio
               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
 RMP           NHS 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                           184
               Worthing and Southlands Hospitals NHS
 RPL           Trust                                                               78



Survival Indicators Methodology         Page 22 of 31
 Table 3a. Elective hip replacement banding: “within the expected range”
 Trust code Trust name                                    Standardised Mortality ratio
 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 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                         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                                   76
                Barnsley Hospital NHS
 RFF            Foundation Trust                                      58



Survival Indicators Methodology        Page 23 of 31
 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

                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



Survival Indicators Methodology        Page 27 of 31
 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                                              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, C96

Metastatic cancer                 C77, C78, C79, C80                                                     3
Severe liver disease              K729, K766, K767, K721                                                 3
HIV                               B20, B21, B22, B23, B24                                                6




Survival Indicators Methodology              Page 30 of 31
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                      0




Survival Indicators Methodology                 Page 31 of 31

				
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