Volume and in-hospital mortality after emergency abdominal surgery: a national population-based study
| Autor: | Jan Sørensen, Laura Hammond, Ken Mealy, Dara O. Kavanagh, Deborah A. McNamara, Deirdre M. Nally, Gintare Valentelyte |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
Adult
Male medicine.medical_specialty emergency laparotomy Hospitals Low-Volume Adolescent Population Psychological intervention Datasets as Topic Comorbidity 03 medical and health sciences Young Adult 0302 clinical medicine Abdomen Medicine surgeon volume Humans 030212 general & internal medicine Hospital Mortality education Surgeon volume Digestive System Surgical Procedures Original Research Aged Clinical governance Aged 80 and over education.field_of_study volume In hospital mortality business.industry Mortality rate Age Factors Gastrointestinal pathology General Medicine Middle Aged Emergency medicine Surgery Female Emergencies business Ireland 030217 neurology & neurosurgery Hospitals High-Volume Abdominal surgery emergency abdominal surgery in-hospital mortality |
| Zdroj: | BMJ Open |
| ISSN: | 2044-6055 |
| Popis: | ObjectivesEmergency abdominal surgery (EAS) refers to high-risk intra-abdominal surgical procedures undertaken for acute gastrointestinal pathology. The relationship between hospital or surgeon volume and mortality of patients undergoing EAS is poorly understood. This study examined this relationship at the national level.DesignThis is a national population-based study using a full administrative inpatient dataset (National Quality Assurance Improvement System) from publicly funded hospitals in Ireland.Setting24 public hospitals providing EAS services.Participants and InterventionsPatients undergoing EAS as identified by primary procedure codes during the period 2014–2018.Main outcome measuresThe main outcome measure was adjusted in-hospital mortality following EAS in publicly funded Irish hospitals. Mortality rates were adjusted for sex, age, admission source, Charlson Comorbidity Index, procedure complexity, organ system and primary diagnosis. Differences in overall, 7-day and 30-day in-hospital mortality for hospitals with low (ResultsThe study included 10 344 EAS episodes. 798 in-hospital deaths occurred, giving an overall in-hospital mortality rate of 77 per 1000 episodes. There was no statistically significant difference in adjusted mortality rate between low and high volume hospitals. Low volume surgical teams had a higher adjusted mortality rate (85.4 deaths/1000 episodes) compared with high volume teams (54.7 deaths/1000 episodes), a difference that persisted among low volume surgeons practising in high volume hospitals.ConclusionPatients undergoing EAS managed by high volume surgeons have better survival outcomes. These findings contribute to the ongoing discussion regarding configuration of emergency surgery services and emphasise the need for effective clinical governance regarding observed variation in outcomes within and between institutions. |
| Databáze: | OpenAIRE |
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