The delivery of high-risk emergency general surgery across the dr foster global comparators network: an examination of international outcomes

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Title: The delivery of high-risk emergency general surgery across the dr foster global comparators network: an examination of international outcomes
Authors: Chana, P
Casey, N
Chang, D
Joy, M
Burns, E
Arora, S
Darzi, A
Peden, C
Faiz, O
Item Type: Conference Paper
Abstract: Introduction The Dr Foster Global Comparators Network (GC) aims to improve quality in healthcare by promoting inter-hospital collaboration through sharing of outcome data and benchmarking standards. This study aims to utilise the GC database to establish whether geographical differences in outcomes exist following high-risk emergency general surgery (EGS) admissions, whilst determining if structural differences between healthcare systems can be linked to high-quality care. Method Discharge data for a cohort of EGS patients were collated using a pre-determined protocol. 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 with high-risk EGS diagnoses from 2007–2012 were identified. Outcomes including: seven/thirty-day mortality, readmission and length of stay were all superior in the USA. 19,082 patients (27%) underwent emergency abdominal surgery. No geographical differences in mortality were seen at seven-days in this subgroup. Thirty-day mortality (OR = 1.47) readmission (OR = 1.42) and length of stay (OR = 1.98) were all worse in the UK. Across this cohort, patient factors, (age, pathology and co-morbidity) were significantly associated with worse outcome as were structural factors including: low ITU bed ratios, high unit volume and inter-hospital transfers. Having dedicated EGS teams cleared of elective commitments with formalised handover of patients was associated with shorter length of stay. Conclusion Post-operative outcomes were similar at seven but not at thirty-days. This may be attributable to better infrastructure and resource allocation towards EGS in the US. The costs associated with this healthcare gain were not measured.
Issue Date: 22-Jun-2015
Date of Acceptance: 22-Jun-2015
URI: http://hdl.handle.net/10044/1/64025
DOI: https://dx.doi.org/10.1136/gutjnl-2015-309861.96
ISSN: 0017-5749
Publisher: BMJ PUBLISHING GROUP
Start Page: A48
End Page: A48
Journal / Book Title: GUT
Volume: 64
Issue: Suppl 1
Copyright Statement: © 2015 The Author(s). Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions. This article has been accepted for publication in Gut following peer review. The definitive copyedited, typeset version Chana P, Casey N, Chang D, et al OC-096 The delivery of high-risk emergency general surgery across the dr foster global comparators network: an examination of international outcomes Gut 2015;64:A48, is available online at: https://dx.doi.org/10.1136/gutjnl-2015-309861.96
Conference Name: 2nd Digestive-Disorders-Federation Conference
Keywords: Science & Technology
Life Sciences & Biomedicine
Gastroenterology & Hepatology
1103 Clinical Sciences
1114 Paediatrics And Reproductive Medicine
Publication Status: Published
Start Date: 2015-06-22
Finish Date: 2015-06-25
Conference Place: London, ENGLAND
Online Publication Date: 2015-06-22
Appears in Collections:Department of Surgery and Cancer
Institute of Global Health Innovation



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