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Cohort analysis of outcomes in 69 490 emergency general surgical admissions across an international benchmarking collaborative

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Title: Cohort analysis of outcomes in 69 490 emergency general surgical admissions across an international benchmarking collaborative
Authors: Chana, P
Joy, M
Casey, N
Chang, D
Burns, EM
Arora, S
Darzi, AW
Faiz, OD
Peden, CJ
Item Type: Journal Article
Abstract: Objective This study aims to use the Dr Foster Global Comparators Network (GC) database to examine differences in outcomes following high-risk emergency general surgery (EGS) admissions in participating centres across 3 countries and to determine whether hospital infrastructure factors can be linked to the delivery of high-quality care. Design A retrospective cohort analysis of high-risk EGS admissions using GC's international administrative data set. Setting 23 large hospitals in Australia, England and the USA. Methods Discharge data for a cohort of high-risk EGS patients were collated. Multilevel hierarchical logistic regression analysis was performed to examine geographical and structural differences between GC hospitals. Results 69 490 patients, admitted to 23 centres across Australia, England and the USA from 2007 to 2012, were identified. For all patients within this cohort, outcomes defined as: 7-day and 30-day inhospital mortality, readmission and length of stay appeared to be superior in US centres. A subgroup of 19 082 patients (27%) underwent emergency abdominal surgery. No geographical differences in mortality were seen at 7 days in this subgroup. 30-day mortality (OR=1.47, p<0.01) readmission (OR=1.42, p<0.01) and length of stay (OR=1.98, p<0.01) were worse in English units. Patient factors (age, pathology, comorbidity) were significantly associated with worse outcome as were structural factors, including low intensive care unit bed ratios, high volume and interhospital transfers. Having dedicated EGS teams cleared of elective commitments with formalised handovers was associated with shorter length of stay. Conclusions Key factors that influence outcomes were identified. For patients who underwent surgery, outcomes were similar at 7 days but not at 30 days. This may be attributable to better infrastructure and resource allocation towards EGS in the US and Australian centres.
Issue Date: 1-Mar-2017
Date of Acceptance: 6-Feb-2017
URI: http://hdl.handle.net/10044/1/49556
DOI: https://dx.doi.org/10.1136/bmjopen-2016-014484
ISSN: 2044-6055
Publisher: BMJ Publishing Group
Journal / Book Title: BMJ Open
Volume: 7
Copyright Statement: © 2017 The Authors. ublished by the BMJ Publishing Group Limited. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Keywords: Science & Technology
Life Sciences & Biomedicine
Medicine, General & Internal
General & Internal Medicine
MORTALITY
HOSPITALS
LAPAROTOMY
Emergency Surgery
Outcomes
Publication Status: Published
Article Number: ARTN e014484
Appears in Collections:Department of Surgery and Cancer
Institute of Global Health Innovation