Imperial College London
Alternate

Professor the Lord Darzi of Denham PC KBE FRS FMedSci HonFREng

Faculty of Medicine, Department of Surgery & Cancer

Co-Director of the IGHI, Professor of Surgery
 
 
 
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Contact

 

+44 (0)20 3312 1310a.darzi

 
 
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Location

 

Queen Elizabeth the Queen Mother Wing (QEQM)St Mary's Campus

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Summary

 

Publications

Citation

BibTex format

@article{Chana:2017:10.1136/bmjopen-2016-014484,
author = {Chana, P and Joy, M and Casey, N and Chang, D and Burns, EM and Arora, S and Darzi, AW and Faiz, OD and Peden, CJ},
doi = {10.1136/bmjopen-2016-014484},
journal = {BMJ Open},
title = {Cohort analysis of outcomes in 69 490 emergency general surgical admissions across an international benchmarking collaborative},
url = {http://dx.doi.org/10.1136/bmjopen-2016-014484},
volume = {7},
year = {2017}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - 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 69490 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 19082 patients (27%) underwent emergency abdominal surgery. No geographical differences in mortality were seen at 7days 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 7days but not at 30days. This may be attributable to better infrastructure and resource allocation towards EGS in the US and Australian centres.
AU  - Chana,P
AU  - Joy,M
AU  - Casey,N
AU  - Chang,D
AU  - Burns,EM
AU  - Arora,S
AU  - Darzi,AW
AU  - Faiz,OD
AU  - Peden,CJ
DO  - 10.1136/bmjopen-2016-014484
PY  - 2017///
SN  - 2044-6055
TI  - Cohort analysis of outcomes in 69 490 emergency general surgical admissions across an international benchmarking collaborative
T2  - BMJ Open
UR  - http://dx.doi.org/10.1136/bmjopen-2016-014484
UR  - http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000397876500296&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
UR  - http://hdl.handle.net/10044/1/49556
VL  - 7
ER  -
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