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Mortality of emergency general surgical patients and associations with hospital structures and processes

Mortality of emergency general surgical patients and associations with hospital structures and processes
Mortality of emergency general surgical patients and associations with hospital structures and processes
BACKGROUND: Variations in patient outcomes between providers have been described for emergency admissions, including general surgery. The aim of this study was to investigate whether differences in modifiable hospital structures and processes were associated with variance in mortality, amongst patients admitted for emergency colorectal laparotomy, peptic ulcer surgery, appendicectomy, hernia repair and pancreatitis.

METHODS: Adult emergency admissions in the English NHS were extracted from the Hospital Episode Statistics between April 2005 and March 2010. The association between mortality and structure and process measures including medical and nursing staffing levels, critical care and operating theatre availability, radiology utilization, teaching hospital status and weekend admissions were investigated.

RESULTS: There were 294 602 emergency admissions to 156 NHS Trusts (hospital systems) with a 30-day mortality of 4.2%. Trust-level mortality rates for this cohort ranged from 1.6 to 8.0%. The lowest mortality rates were observed in Trusts with higher levels of medical and nursing staffing, and a greater number of operating theatres and critical care beds relative to provider size. Higher mortality rates were seen in patients admitted to hospital at weekends [OR 1.11 (95% CI 1.06-1.17) P<0.0001], in Trusts with fewer general surgical doctors [1.07 (1.01-1.13) P=0.019] and with lower nursing staff ratios [1.07 (1.01-1.13) P=0.024].

CONCLUSIONS: Significant differences between Trusts were identified in staffing and other infrastructure resources for patients admitted with an emergency general surgical diagnosis. Associations between these factors and mortality rates suggest that potentially modifiable factors exist that relate to patient outcomes, and warrant further investigation.
healthcare delivery, health resources, health services research, outcome
0007-0912
54-62
Ozdemir, B.A.
b6157fdd-8c1a-4802-be87-71827c89c2a3
Sinha, S.
8c214f61-b994-48ae-9f1f-535a46fd9c93
Karthikesalingam, A.
87983f8d-8f2a-4617-86ed-06b2c82e2605
Poloniecki, J.D.
cd8ead3a-a749-47c2-b26a-c46dd87f5dbf
Pearse, R.M.
9a8029d1-5b91-4178-ac79-451ba41df2b2
Grocott, M.P.W.
1e87b741-513e-4a22-be13-0f7bb344e8c2
Thompson, M.M.
670cba75-d1af-421c-bc12-b0c85b6c885b
Holt, P.J.E.
dc743e59-2815-496b-8320-c6a867ef00cc
Ozdemir, B.A.
b6157fdd-8c1a-4802-be87-71827c89c2a3
Sinha, S.
8c214f61-b994-48ae-9f1f-535a46fd9c93
Karthikesalingam, A.
87983f8d-8f2a-4617-86ed-06b2c82e2605
Poloniecki, J.D.
cd8ead3a-a749-47c2-b26a-c46dd87f5dbf
Pearse, R.M.
9a8029d1-5b91-4178-ac79-451ba41df2b2
Grocott, M.P.W.
1e87b741-513e-4a22-be13-0f7bb344e8c2
Thompson, M.M.
670cba75-d1af-421c-bc12-b0c85b6c885b
Holt, P.J.E.
dc743e59-2815-496b-8320-c6a867ef00cc

Ozdemir, B.A., Sinha, S., Karthikesalingam, A., Poloniecki, J.D., Pearse, R.M., Grocott, M.P.W., Thompson, M.M. and Holt, P.J.E. (2016) Mortality of emergency general surgical patients and associations with hospital structures and processes. British Journal of Anaesthesia, 116 (1), 54-62. (doi:10.1093/bja/aev372). (PMID:26675949)

Record type: Article

Abstract

BACKGROUND: Variations in patient outcomes between providers have been described for emergency admissions, including general surgery. The aim of this study was to investigate whether differences in modifiable hospital structures and processes were associated with variance in mortality, amongst patients admitted for emergency colorectal laparotomy, peptic ulcer surgery, appendicectomy, hernia repair and pancreatitis.

METHODS: Adult emergency admissions in the English NHS were extracted from the Hospital Episode Statistics between April 2005 and March 2010. The association between mortality and structure and process measures including medical and nursing staffing levels, critical care and operating theatre availability, radiology utilization, teaching hospital status and weekend admissions were investigated.

RESULTS: There were 294 602 emergency admissions to 156 NHS Trusts (hospital systems) with a 30-day mortality of 4.2%. Trust-level mortality rates for this cohort ranged from 1.6 to 8.0%. The lowest mortality rates were observed in Trusts with higher levels of medical and nursing staffing, and a greater number of operating theatres and critical care beds relative to provider size. Higher mortality rates were seen in patients admitted to hospital at weekends [OR 1.11 (95% CI 1.06-1.17) P<0.0001], in Trusts with fewer general surgical doctors [1.07 (1.01-1.13) P=0.019] and with lower nursing staff ratios [1.07 (1.01-1.13) P=0.024].

CONCLUSIONS: Significant differences between Trusts were identified in staffing and other infrastructure resources for patients admitted with an emergency general surgical diagnosis. Associations between these factors and mortality rates suggest that potentially modifiable factors exist that relate to patient outcomes, and warrant further investigation.

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More information

Accepted/In Press date: 8 August 2015
Published date: January 2016
Keywords: healthcare delivery, health resources, health services research, outcome
Organisations: NIHR Southampton Respiratory Biomedical Research Unit

Identifiers

Local EPrints ID: 389813
URI: http://eprints.soton.ac.uk/id/eprint/389813
ISSN: 0007-0912
PURE UUID: fb5fbdae-660e-4ded-b5a3-384f9b5c9d6f
ORCID for M.P.W. Grocott: ORCID iD orcid.org/0000-0002-9484-7581

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Date deposited: 15 Mar 2016 16:54
Last modified: 15 Mar 2024 03:33

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Contributors

Author: B.A. Ozdemir
Author: S. Sinha
Author: A. Karthikesalingam
Author: J.D. Poloniecki
Author: R.M. Pearse
Author: M.P.W. Grocott ORCID iD
Author: M.M. Thompson
Author: P.J.E. Holt

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