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  • Journal article
    Aylin P, Bennett P, Bottle A, Brett S, Sodhi V, Rivers A, Balinskaite Vet al., 2016,

    The risk of adverse pregnancy outcomes following non-obstetric surgery during pregnancy: An observational study

    , BJOG-An International Journal of Obstetrics and Gynaecology, Vol: 123, Pages: 84-84, ISSN: 1471-0528
  • Journal article
    Bottle RA, Goudie R, Bell D, Aylin P, Cowie Met al., 2016,

    Use of hospital services by age and comorbidity after an index heart failure admission in England: an observational study

    , BMJ Open, Vol: 6, ISSN: 2044-6055

    Objectives: To describe hospital inpatient, emergency department (ED) and outpatient department (OPD) activity for patients in the year following their first emergency admission for heart failure (HF). To assess the proportion receiving specialist assessment within two weeks of hospital discharge, as now recommended by guidelines.Design: Observational study of national administrative data.Setting: all acute NHS hospitals in England.Participants: 82,241 patients with an index emergency admission between April 2009 and March 2011 with a primary diagnosis of HF.Main outcome measures: cardiology OPD appointment within two weeks and within a year of discharge from the index admission; emergency department (ED) and inpatient use within a yearResults: 15.1% died during the admission. Of the 69,848 survivors, 19.7% were readmitted within 30 days and half within a year, the majority for non-HF diagnoses. 6.7% returned to the ED within a week of discharge, of whom the majority (77.6%) were admitted. The two most common OPD specialties during the year were cardiology (24.7% of the total appointments) and anticoagulant services (12.5%). Although half of all patients had a cardiology appointment within a year, the proportion within the recommended two weeks of discharge was just 6.8% overall and varied by age, from 2.4% in those aged 90+ to 19.6% in those aged 18-45 (p<0.0001); appointments in other specialties made up only some of the shortfall. More comorbidity at any age was associated with higher rates of cardiology OPD follow-up. Conclusion: patients with HF are high users of hospital services. Post-discharge cardiology OPD follow-up rates fell well below current NICE guidelines, particularly for the elderly and those with less comorbidity.

  • Journal article
    Mamidanna R, Nachiappan S, Bottle A, Aylin P, Faiz Oet al., 2016,

    Defining the timing and causes of death amongst patients undergoing colorectal resection in England

    , Colorectal Disease, Vol: 18, Pages: 586-593, ISSN: 1463-1318
  • Journal article
    King AS, Bottle R, Faiz O, Aylin Pet al., 2016,

    Investigating adverse event free admissions in Medicare inpatients as a patient safety indicator

    , Annals of Surgery, Vol: 265, Pages: 910-915, ISSN: 1528-1140

    Objective: To investigate adverse event free admissions as a potential,patient-centered indicator aligned directly with the goal of patient safety—freedom from harm.Background: Preventable adverse event rates in healthcare could be furtherreduced. These are generally measured separately, one adverse event at a time.However, this does not reveal whether different patients are affected or thesame patients are experiencing multiple events.Methods: We examined Medicare inpatient hospital administrative datasetsfor 2009 to 2011, processed using standard criteria. Events were (i) deathwithin 30 days, (ii) unplanned readmissions within 30 days, (iii) long length ofstay, (iv) healthcare acquired infections, and (v) established patient safetyindicators not present on admission. We defined adverse event free admissionsas those without record of any of these events. National rates were calculatedby diagnosis group. Risk-adjusted hospital-specific rates of adverse event freeadmissions were calculated using colorectal procedures as an example.Results: There were 23,991,193 admissions after exclusions. Approximately,64% went through the acute inpatient Medicare system without record ofanything untoward. Multiple events were recorded in 227% admissions; 15%of these experienced more than 2 adverse events. Risk-adjusted hospitalspecificrates of adverse event free admissions for colorectal proceduresshowed 131 out of 3786 hospitals below the 998% lower control limit of thenational upper quartile.Conclusions: Overall, only 60% of admissions were recorded as adverseevent free. Multiple adverse events were common. Even if events are underrecorded, this measure could provide an easily understandable and usefulbaseline for clinicians and managers.

  • Journal article
    Askari A, Nachiappan S, Currie A, Bottle A, Athanasiou T, Faiz Oet al., 2016,

    Selection for laparoscopic resection confers a survival benefit in colorectal cancer surgery in England.

    , Surgical Endoscopy, ISSN: 0930-2794

    INTRODUCTION: Laparoscopic surgery is being increasingly used in colorectal cancer resections. The aim of this national study was to determine whether laparoscopy confers a long-term survival advantage in colorectal cancer. METHODS: A national administrative data set (Hospital Episode Statistics-HES) encompassing all elective hospital admissions in England between 2001 and 2011 was analysed. All patients that had a colorectal cancer resection (open or laparoscopic) were identified. Cox hazard regression was used to determine differences in overall survival (10 year) between the open and laparoscopy groups. RESULTS: A total of 141,682 patients underwent elective surgery for colorectal cancer, of which 20.9 % (n = 29,550) had a laparoscopic procedure. The median 5-year survival in the open group was 36.1 months compared with 46.1 months in the laparoscopic group (p = <0.001). Survival analysis demonstrated laparoscopy to be an independent predictor of survival. Patients who underwent laparoscopic resection were 18 % less likely to die than patients who had an open CRC resection (HR 0.82, CI 0.79-0.83, p < 0.001). This survival benefit persisted even when initial post-operative mortality (90 day) was excluded (HR 0.87, CI 0.85-0.90, p < 0.001). Subgroup analysis, exploring the effect of CRC laparoscopic surgery on survival in the elderly (>79 years old), demonstrated similar survival benefit amongst patients treated using laparoscopy (HR 0.90, CI 0.86-0.94, p < 0.001). Patients not undergoing adjuvant chemotherapy were more likely to survive if they underwent laparoscopic resection (HR 0.81, CI 0.78-0.83, p < 0.001). Similarly, patients undergoing adjuvant chemotherapy demonstrated a survival benefit if a minimal access surgical approach was utilised (HR 0.86, CI 0.81-0.91, p < 0.001). CONCLUSION: Laparoscopy confers a survival benefit, irrespec

  • Journal article
    Mamidanna R, Ni Z, Anderson O, Spiegelhalter D, Bottle A, Aylin P, Faiz O, Hanna GBet al., 2016,

    Surgeon Volume and Cancer Esophagectomy, Gastrectomy, and Pancreatectomy: A Population-based Study in England

    , Annals of Surgery, Vol: 263, Pages: 727-732, ISSN: 1528-1140

    Objective: The aim of the study was to assess whether there is a proficiency curve-like relationship between surgeon volume and operative mortality and determine the minimum surgeon volume for optimum operative mortality.Background: The inverse relationship between hospital volume and operative mortality is well-established for esophageal, gastric, and pancreatic cancer. The recommended minimum surgeon volumes are however uncertain.Methods: We retrieved data on esophagectomies, gastrectomies, and pancreatectomies for cancer from the NHS Hospital Episodes Statistics database from April 2000 to March 2010. We defined mortality as in-hospital death within 30 days of surgery. We determined whether there was a proficiency curve relationship by inspecting surgeon volume-mortality graphs after adjusting for patient age, sex, socioeconomic, and comorbidity indices. We then statistically determined the minimum surgeon volume that produced a mortality rate insignificantly different from the optimum of the curve.Results: Sixteen thousand five hundred seventy-two esophagectomies, 12,622 gastrectomies, and 9116 pancreatectomies were examined. Surgeon volume ranged from 2 to 29 esophagectomies, from 1 to 14 gastrectomies, and from 2 to 31 pancreatectomies per surgeon per year. We demonstrated a proficiency relationship between surgeon volume and mortality in esophageal, gastric, and pancreatic cancer surgery. Each additional case of esophagectomy, gastrectomy, and pancreatectomy would reduce 30-day mortality odds by 3.4%, 7.2%, and 4.1%, respectively. However, as surgeon volume increased, mortality rate continued to improve. Therefore, we were unable to recommend minimum surgeon volume.Conclusions: Mortality after resections for esophageal, gastric, and pancreatic cancer falls as surgeon volume rises up to 30 cases. Within this range, we did not demonstrate any statistical threshold that could be recommended as a minimum volume target.

  • Journal article
    Cecil E, Bottle A, Cowling TE, Majeed A, Wolfe I, Saxena Set al., 2016,

    Primary Care Access, Emergency Department Visits, and Unplanned Short Hospitalizations in the UK

    , PEDIATRICS, Vol: 137, ISSN: 0031-4005
  • Journal article
    Rost NS, Bottle A, Lee J-M, Randall M, Middleton S, Shaw L, Thijs V, Rinkel GJE, Hemmen TMet al., 2016,

    Stroke Severity Is a Crucial Predictor of Outcome: An International Prospective Validation Study

    , Journal of the American Heart Association, Vol: 5, ISSN: 2047-9980

    Background Stroke is among the leading causes of morbidity and mortality worldwide. Without reliable prediction models and outcome measurements, comparison of care systems is impossible. We analyzed prospectively collected data from 4 countries to explore the importance of stroke severity in outcome prediction.Methods and Results For 2 months, all acute ischemic stroke patients from the hospitals participating in the Global Comparators Stroke GOAL (Global Outcomes Accelerated Learning) collaboration received a National Institutes of Health Stroke Scale (NIHSS) score on admission and a modified Rankin Scale score at 30 and 90 days. These data were added to the administrative data set, and risk prediction models including age, sex, comorbidity index, and NIHSS were derived for in‐hospital death within 7 days, all in‐hospital death, and death and good outcome at 30 and 90 days. The relative importance of each variable was assessed using the proportion of explained variation. Of 1034 admissions for acute ischemic stroke, 614 had a full set of NIHSS and both modified Rankin Scale values recorded; of these, 507 patients could be linked to administrative data. The marginal proportion of explained variation was 0.7% to 4.0% for comorbidity index, and 11.3 to 25.0 for NIHSS score. The percentage explained by the model varied by outcome (16.6–29.1%) and was highest for good outcome at 30 and 90 days. There was high agreement between 30‐ and 90‐day modified Rankin Scale scores (weighted κ=0.82).Conclusions In this prospective pilot study, the baseline NIHSS score was essential for prediction of acute ischemic stroke outcomes, followed by age; whereas traditional comorbidity index contributed little to the overall model. Future studies of stroke outcomes between different care systems will benefit from including a baseline NIHSS score.

  • Journal article
    Bouras G, Burns EM, Howell A, Bottle R, Athanasiou T, darzi Aet al., 2015,

    Risk of Post-Discharge Venous Thromboembolism and Associated Mortality in General Surgery: A Population-Based Cohort Study Using Linked Hospital and Primary Care Data in England

    , PLOS One, ISSN: 1932-6203
  • Journal article
    Aylin PP, Ruiz M, Bottle A, 2016,

    Exploring the impact of Consultants’ experience on hospital mortality by day of the week: a retrospective analysis of hospital episode statistics

    , BMJ Quality & Safety, ISSN: 2044-5423

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