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- Title
Mortality in high-risk emergency general surgical admissions.
- Authors
Symons, N. R. A.; Moorthy, K.; Almoudaris, A. M.; Bottle, A.; Aylin, P.; Vincent, C. A.; Faiz, O. D.
- Abstract
Background There is increasing evidence of variable standards of care for patients undergoing emergency general surgery in the National Health Service ( NHS). The aim of this study was to quantify and explore variability in mortality amongst high-risk emergency general surgery admissions to English NHS hospital Trusts. Methods The Hospital Episode Statistics ( HES) database was used to identify high-risk emergency general surgery diagnoses (greater than 5 per cent national 30-day mortality rate). Adults admitted to English NHS Trusts with these diagnoses between 2000 and 2009 were included in the study. Thirty-day in-hospital mortality was adjusted for patient and hospital factors. Trusts were grouped into high- and low-mortality outliers, and resource availability was compared between high- and low-mortality outlier institutions. Results Some 367 796 patients admitted to 145 hospital Trusts were included in the study; the 30-day mortality rate was 15·6 per cent (institutional range 9·2-18·2 per cent). Fourteen and 24 hospital Trusts were identified as high- and low-mortality outlier institutions respectively. Intensive care and high-dependency bed resources, as well as greater institutional use of computed tomography ( CT), were independent predictors of reduced mortality ( P < 0·001). Low-mortality outlying Trusts had significantly more intensive care beds per 1000 hospital beds (20·8 versus 14·0; P = 0·017) and made significantly greater use of CT (24·6 versus 17·2 scans per bed per year; P < 0·001) and ultrasonography (42·5 versus 30·2 scans per bed per year; P < 0·001). Conclusion There is significant variability in mortality risk between hospital Trusts treating high-risk emergency general surgery patients. Equitable access to essential hospital resources may reduce variability in outcomes.
- Subjects
SURGICAL emergencies; HOSPITAL admission &; discharge; MORTALITY; GREAT Britain. National Health Service; INTENSIVE care units; ULTRASONIC imaging
- Publication
British Journal of Surgery, 2013, Vol 100, Issue 10, p1318
- ISSN
0007-1323
- Publication type
Article
- DOI
10.1002/bjs.9208