Impact of hospital institutional volume on postoperative mortality after major emergency colorectal surgery in English National Health Service Trusts, 2001 to 2005.

Purpose: The aim of this study was to investigate the effects of institutional volume on postoperative mortality in patients undergoing emergency major colorectal surgical procedures in England between 2001 and 2005.

Methods: All of the emergency excisional colorectal procedures performed between the above dates were included from the Hospital Episode Statistics data set. Institutions were divided into high-, medium-, and low-volume tertiles according to the total major emergency colorectal caseload.

The volume-mortality relation for radical cystectomy in England: retrospective analysis of hospital episode statistics.

Objectives: To investigate the relation between volume and mortality after adjustment for case mix for radical cystectomy in the English healthcare setting using improved statistical methodology, taking into account the institutional and surgeon volume effects and institutional structural and process of care factors.

Design: Retrospective analysis of hospital episode statistics using multilevel modelling.

Setting: English hospitals carrying out radical cystectomy in the seven financial years 2000/1 to 2006/7.

Increasing skin infections and Staphylococcus aureus complications in children, England, 1997-2006.

During 1997-2006, general practitioner consultations for skin conditions for children <18 years of age in England increased 19%, from 128.5 to 152.9/1,000 child-years, and antistaphylococcal drug prescription rates increased 64%, from 17.

The hospital standardised mortality ratio: a powerful tool for Dutch hospitals to assess their quality of care?

Aim Of The Study: To use the hospital standardised mortality ratio (HSMR), as a tool for Dutch hospitals to analyse their death rates by comparing their risk-adjusted mortality with the national average.

Method: The method uses routine administrative databases that are available nationally in The Netherlands--the National Medical Registration dataset for the years 2005-2007. Diagnostic groups that led to 80% of hospital deaths were included in the analysis.

Weekend mortality for emergency admissions. A large, multicentre study.

Background: Several studies have identified higher mortality for patients admitted as emergencies at the weekend compared with emergency admissions during the week, but most have focused on specific conditions or have had a limited sample size.

Methods: Using routinely collected hospital administrative data, we examined in-hospital deaths for all emergency inpatient admissions to all public acute hospitals in England for 2005/2006. Odds of death were calculated for admissions at the weekend compared to admissions during the week, adjusted for age, sex, socioeconomic deprivation, comorbidity and diagnosis.

The impact of national guidelines for the prophylaxis of venous thromboembolism on the complications of arthroplasty of the lower limb.

The National Institute for Clinical Excellence (NICE) produces recommendations on appropriate treatment within the National Health Service (NHS) in England and Wales. The NICE guidelines on prophylaxis for venous thromboembolism in orthopaedic surgery recommend that all patients be offered a low molecular weight heparin (LMWH). The linked hospital episode statistics of 219 602 patients were examined to determine the rates of complications following lower limb arthroplasty for the 12-month periods prior to and following the publication of these guidelines.

Trends in lower extremity amputations in people with and without diabetes in England, 1996-2005.

Aims: To examine trends in non-traumatic lower extremity amputations over a 10-year-period in people with and without diabetes (DM) in England.

Methods: All individuals admitted to NHS hospitals for non-traumatic amputations between 1996 and 2005 in England were identified using hospital activity data. Postoperative and 1-year mortality were examined between 2000 and 2004.

Laparoscopically assisted vs. open elective colonic and rectal resection: a comparison of outcomes in English National Health Service Trusts between 1996 and 2006.

Purpose: This study was designed to compare outcomes after elective laparoscopic and conventional colorectal surgery over a ten-year period using data from the English National Health Service Hospital Episode Statistics database.

Methods: All elective colonic and rectal resections carried out in English Trusts between 1996 and 2006 were included. Univariate and multivariate analyses were used to compare 30 and 365-day mortality rates, 28-day readmission rates, and length of stay between laparoscopic and open surgery.

Increasing short-stay unplanned hospital admissions among children in England; time trends analysis '97-'06.

Background: Timely care by general practitioners in the community keeps children out of hospital and provides better continuity of care. Yet in the UK, access to primary care has diminished since 2004 when changes in general practitioners' contracts enabled them to 'opt out' of providing out-of-hours care and since then unplanned pediatric hospital admission rates have escalated, particularly through emergency departments. We hypothesised that any increase in isolated short stay admissions for childhood illness might reflect failure to manage these cases in the community over a 10 year period spanning these changes.

Early in-hospital mortality following trainee doctors' first day at work.

Background: There is a commonly held assumption that early August is an unsafe period to be admitted to hospital in England, as newly qualified doctors start work in NHS hospitals on the first Wednesday of August. We investigate whether in-hospital mortality is higher in the week following the first Wednesday in August than in the previous week.

Methodology: A retrospective study in England using administrative hospital admissions data.

Pay for perfomance and the quality of diabetes management in individuals with and without co-morbid medical conditions.

Objective: To examine the impact of the Quality and Outcomes Framework, a major pay-for-performance incentive introduced in the UK during 2004, on diabetes management in patients with and without co-morbidity.

Design: Cohort study comparing actual achievement of treatment targets in 2004 and 2005 with that predicted by the underlying (pre-intervention) trend in diabetes patients with and without co-morbid conditions.

Setting: A total of 422 general practices participating in the General Practice Research Database.

Diverticular disease hospital admissions are increasing, with poor outcomes in the elderly and emergency admissions.

Background: Diverticular disease has a changing disease pattern with limited epidemiological data.

Aim: To describe diverticular disease admission rates and associated outcomes through national population study.

Methods: Data were obtained from the English 'Hospital Episode Statistics' database between 1996 and 2006.

Application of AHRQ patient safety indicators to English hospital data.

Background: Patient safety is recognised worldwide as a major healthcare issue. The US Agency for Healthcare Research and Quality developed a series of evidence-based Patient Safety Indicators for use with hospital administrative data, but to date these have not been translated for use in the UK. They measure harm due to treatment and include infections, obstetric tears and foreign bodies left in the patient following surgery.

Provision of radical pelvic urological surgery in England, and compliance with improving outcomes guidance.

Objective: To investigate compliance with Improving Outcomes Guidance (IOG) for radical pelvic surgery in England, and explore the pattern of service provision for radical cystectomy (RC) and radical prostatectomy (RP) before and after the introduction of IOG.

Methods: For the period 2000/01-2006/07, all admissions for RC and RP were extracted from Hospital Episode Statistics (HES). At the institutional level, the numbers of RC and RP cases were combined to assess adherence to IOG.

Funnel plots and their emerging application in surgery.

Objective: To familiarize surgeons with the use of funnel plots as a control tool to assess quality in surgery.

Summary Background Data: Surgical outcomes are an important component of quality in healthcare delivery. Several control tools have been introduced and tested including the use of graphical tools such as funnel plots.

Ethnic disparities in blood pressure management in patients with hypertension after the introduction of pay for performance.

Purpose: Little is known about the impact of pay-for-performance incentives on health care disparities. We examined ethnic disparities in the management of hypertension among patients with and without cardiovascular comorbidities after the implementation of a major pay-for-performance incentive scheme in UK primary care.

Methods: We undertook a population-based, cross-sectional survey of medication prescriptions and blood pressure control among patients with hypertension using electronic medical records from 16 family practices in southwest London.

Traditional and laparoscopic appendectomy in adults: outcomes in English NHS hospitals between 1996 and 2006.

Objective: This study investigated length of stay, readmission rates, and postoperative mortality in adult patients undergoing traditional and laparoscopic appendectomy in England between April 1, 1996, and March 31, 2006.

Methods: All procedures coded to the "H01-Emergency Excision of Appendix" procedure code in the Hospital Episode Statistics database were included. Multivariate analyses were used to identify independent predictors of length of hospital stay, 30-day and 365-day mortality.

Trends in cardiovascular admissions and procedures for people with and without diabetes in England, 1996-2005.

Aims/hypothesis: The aim of this study was to compare 10-year trends in admissions, with and without diabetes recorded, for myocardial infarction, angina, stroke, percutaneous coronary interventions (PCI) and coronary artery bypass graft (CABG).

Methods: We used national hospital-activity data in England collected between 1996 and 2005 and compared trends in admissions, after adjusting for age, sex and area-level deprivation.

Results: Overall, there was a modest fall in the number of admissions for angina and little change in the numbers of admissions for myocardial infarction (MI) and stroke.

Descriptive study of selected healthcare-associated infections using national Hospital Episode Statistics data 1996-2006 and comparison with mandatory reporting systems.

Using Hospital Episode Statistics (HES) data from England for the period 1996-2006, we performed a descriptive study to compare records of Clostridium difficile for inpatients aged >or=65 years and for all patients following any of four types of orthopaedic procedures. Results showed that infection rates for C. difficile increased whereas rates for orthopaedic surgical site infections (SSIs) decreased.

Laparoscopic and conventional appendicectomy in children: outcomes in English hospitals between 1996 and 2006.

Background: Laparoscopic appendicectomy is increasingly used in children. This national retrospective study compared outcomes of paediatric open and laparoscopic appendicectomy.

Methods: Length of stay, readmission rates and mortality in children undergoing open and laparoscopic appendicectomy in English NHS Trusts between 1 April 1996 and 31 March 2006 were compared.

Trends in hospital admissions for pulmonary embolism in England: 1996/7 to 2005/6.

Pulmonary embolism (PE) can be difficult to diagnose and manage. This paper examines recent national trends in admission rates and mortality for PE to help inform clinical practice. Admissions to NHS hospitals in England between 1 April 1996 and 31 March 2006 were studied.

Quality of primary care and hospital admissions for diabetes mellitus in England.

The National Health Service in England has invested substantially in recent years to improve the quality of primary care services for patients with chronic diseases such as diabetes. A key aim of this investment is to reduce associated complication rates and decrease consequent hospital admission rates. The goal of the study was to examine associations between the quality of primary care services and hospital admission rates for diabetes mellitus in England.