Publications
409 results found
Mamidanna R, Ni Z, Anderson O, et 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.
Askari A, Currie A, Nachiappan S, et al., 2016, The Risk of Developing Cancer in Patients With Inflammatory Bowel Disease (IBD): Does Infliximab Contribute to Risk?, 57th Annual Meeting and Residents Fellow Conference of the Society-for-Surgery-of-the-Alimentary-Tract (SSAT) / 52nd Annual Meeting on Digestive Disease Week (DDW) / Meeting of the American-Gastroenterological-Association (AGA), Publisher: W B SAUNDERS CO-ELSEVIER INC, Pages: S574-S575, ISSN: 0016-5085
Askari A, Currie A, Nachiappan S, et al., 2016, Wide Variation in Resection Rates and Survival in Elderly Colorectal Cancer Patients in England, 57th Annual Meeting and Residents Fellow Conference of the Society-for-Surgery-of-the-Alimentary-Tract (SSAT) / 52nd Annual Meeting on Digestive Disease Week (DDW) / Meeting of the American-Gastroenterological-Association (AGA), Publisher: W B SAUNDERS CO-ELSEVIER INC, Pages: S650-S650, ISSN: 0016-5085
Cecil E, Bottle A, Cowling TE, et al., 2016, Primary Care Access, Emergency Department Visits, and Unplanned Short Hospitalizations in the UK, PEDIATRICS, Vol: 137, ISSN: 0031-4005
- Author Web Link
- Cite
- Citations: 56
Rost NS, Bottle A, Lee J-M, et 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.
Ruiz M, Bottle A, Long S, et al., 2015, Multi-morbidity in hospitalised older patients: who are the complex elderly?, PLOS One, Vol: 10, ISSN: 1932-6203
Bouras G, Burns EM, Howell A, et 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
Byrne BE, Pinto A, Aylin P, et al., 2015, Understanding how colorectal units achieve short length of stay: an interview survey among representative hospitals in England, Patient Safety in Surgery, Vol: 9
Palmer WL, Bottle A, Aylin P, 2015, Association between day of delivery and obstetric outcomes: observational study, BMJ - British Medical Journal, Vol: 351, ISSN: 0959-8138
Study question What is the association between day of delivery and measures of quality and safety of maternity services, particularly comparing weekend with weekday performance?Methods This observational study examined outcomes for maternal and neonatal records (1 332 835 deliveries and 1 349 599 births between 1 April 2010 and 31 March 2012) within the nationwide administrative dataset for English National Health Service hospitals by day of the week. Groups were defined by day of admission (for maternal indicators) or delivery (for neonatal indicators) rather than by day of complication. Logistic regression was used to adjust for case mix factors including gestational age, birth weight, and maternal age. Staffing factors were also investigated using multilevel models to evaluate the association between outcomes and level of consultant presence. The primary outcomes were perinatal mortality and—for both neonate and mother—infections, emergency readmissions, and injuries.Study answer and limitations Performance across four of the seven measures was significantly worse for women admitted, and babies born, at weekends. In particular, the perinatal mortality rate was 7.3 per 1000 babies delivered at weekends, 0.9 per 1000 higher than for weekdays (adjusted odds ratio 1.07, 95% confidence interval 1.02 to 1.13). No consistent association between outcomes and staffing was identified, although trusts that complied with recommended levels of consultant presence had a perineal tear rate of 3.0% compared with 3.3% for non-compliant services (adjusted odds ratio 1.21, 1.00 to 1.45). Limitations of the analysis include the method of categorising performance temporally, which was mitigated by using a midweek reference day (Tuesday). Further research is needed to investigate possible bias from unmeasured confounders and explore the nature of the causal relationship.What this study adds This study provides an evaluation of the “weekend
Palmer WL, Bottle A, Aylin PP, 2015, The association between day of delivery and obstetric outcomes: an observational study, The BMJ, Vol: 351, ISSN: 0959-8138
Objective To examine the association between day of delivery and measures of quality and safety of maternity services and, in particular, compare weekend with weekday performance.Design We examined outcomes for maternal and neonatal records within the nationwide administrative dataset for English hospitals by day of the week. Groups were defined by day of admission (for maternal indicators) or delivery (for neonatal indicators) rather than by day of complication. We used logistic regression to adjust for case-mix factors including gestational age, birth-weight, and maternal age. We also investigated staffing factors using multi-level models to evaluate the association between outcomes and level of consultant presence. Setting English National Health Service public hospitals.Participants 1,332,835 deliveries and 1,349,599 births between 1 April 2010 and 31 March 2012. Main outcome measures The primary outcomes were perinatal mortality and – for both neonate and mother – infections, emergency readmissions and injuries.Results Performance across four of the seven measures was significantly worse for women admitted, and babies born, at weekends. In particular, the perinatal mortality rate was 7.3 per 1,000 babies delivered at weekends, 0.9 per 1,000 higher than at weekdays (adjusted odds ratio [AOR] 1.07; 95% confidence interval 1.02 to 1.13). We did not identify a consistent association between outcomes and staffing, although trusts who complied with recommended levels of consultant presence had a perineal tear rate of 3.0% compared with 3.3% for non-compliant services (AOR 1.21; 1.00 to 1.45).Conclusion The study suggests an association between day of delivery and aspects of performance, and some outcomes appear worse for both women admitted, and babies born, at the weekend. The results would suggest approximately 770 perinatal deaths and 470 maternal infections per year above what might be expected if performance was consistent across women admitted, and
Bottle A, Goudie R, Cowie MR, et al., 2015, Relation between process measures and diagnosis-specific readmission rates in patients with heart failure, HEART, Vol: 101, Pages: 1704-1710, ISSN: 1355-6037
- Author Web Link
- Cite
- Citations: 12
Bottle A, Oragui E, Pinder E, et al., 2015, The effect of new oral anticoagulants and extended thromboprophylaxis policy on hip and knee arthroplasty outcomes: observational study, Arthroplasty Today, Vol: 1, Pages: 45-50, ISSN: 2352-3441
The efficacy and safety of the new oral anticoagulants (NOAC) and the benefits of extended duration thromboprophylaxis following hip and knee replacements remain uncertain. This observational study describes the relations between thromboprophylaxis policies following hip and knee replacements across England's NHS and patient outcomes between January 2008 and December 2011. From the national administrative database, we analyzed mortality, thromboembolic complications, emergency readmission, and bleeding rates for 201,418 hip and 230,282 knee replacements. There were no differences in outcomes for either LMWH or NOAC. We found no advantage in favor of any single anticoagulation policy or in changing policy. This study supports the American Academy of Orthopaedic Surgeons' recommendation that the choice and duration of thromboprophylaxis prophylaxis be decided by the treating surgeon.
Saxena S, Atchison C, Cecil E, et al., 2015, Additive impact of pneumococcal conjugate vaccines on pneumonia and empyema hospital admissions in England, JOURNAL OF INFECTION, Vol: 71, Pages: 428-436, ISSN: 0163-4453
- Author Web Link
- Cite
- Citations: 35
Samra R, Bottle A, Aylin P, 2015, Monitoring patient safety in primary care: an exploratory study using in-depth semistructured interviews, BMJ Open, Vol: 5, ISSN: 2044-6055
Leff DR, Bottle A, Mayer E, et al., 2015, Trends in immediate postmastectomy breast reconstruction in the United Kingdom, Plastic and Reconstructive Surgery, Global Open, Vol: 3, ISSN: 2169-7574
Background: The study aimed to evaluate local and national trends in immediate breast reconstruction (IBR) using the national English administrative records, Hospital Episode Statistics. Our prediction was an increase in implant-only and free flap procedures and a decline in latissimus flap reconstructions.Methods: Data from an oncoplastic center were interrogated to derive numbers of implant-only, autologous latissimus dorsi (LD), LD-assisted, and autologous pedicled or free flap IBR procedures performed between 2004 and 2013. Similarly, Hospital Episode Statistics data were used to quantify national trends in these procedures from 1996 to 2012 using a curve fitting analysis.Results: National data suggest an increase in LD procedures between 1996 (n = 250) and 2002 (n = 958), a gradual rise until 2008 (n = 1398) followed by a decline until 2012 (n = 1090). As a percentage of total IBR, trends in LD flap reconstruction better fit a quadratic (R2 = 0.97) than a linear function (R2 = 0.63), confirming a proportional recent decline in LD flap procedures. Conversely, autologous (non-LD) flap reconstructions have increased (1996 = 0.44%; 2012 = 2.76%), whereas implant-only reconstructions have declined (1996 = 95.42%; 2012 = 84.92%). Locally, 70 implant-assisted LD procedures were performed in 2003 -2004, but only 2 were performed in 2012 to 2013.Conclusions: Implants are the most common IBR technique; autologous free flap procedures have increased, and pedicled LD flap procedures are in decline.
Cowling TE, Harris M, Watt H, et al., 2015, Access to primary care and the route of emergency admission to hospital: retrospective analysis of national hospital administrative data, BMJ Quality & Safety, Vol: 25, Pages: 432-440, ISSN: 2044-5415
Background The UK government is pursuing policies to improve primary care access, as many patients visit accident and emergency (A and E) departments after being unable to get suitable general practice appointments. Direct admission to hospital via a general practitioner (GP) averts A and E use, and may reduce total hospital costs. It could also enhance the continuity of information between GPs and hospital doctors, possibly improving healthcare outcomes.Objective To determine whether primary care access is associated with the route of emergency admission—via a GP versus via an A and E department.Methods Retrospective analysis of national administrative data from English hospitals for 2011–2012. Adults admitted in an emergency (unscheduled) for ≥1 night via a GP or an A and E department formed the study population. The measure of primary care access—the percentage of patients able to get a general practice appointment on their last attempt—was derived from a large, nationally representative patient survey. Multilevel logistic regression was used to estimate associations, adjusting for patient and admission characteristics.Results The analysis included 2 322 112 emergency admissions (81.9% via an A and E department). With a 5 unit increase in the percentage of patients able to get a general practice appointment on their last attempt, the adjusted odds of GP admission (vs A and E admission) was estimated to increase by 15% (OR 1.15, 95% CI 1.12 to 1.17). The probability of GP admission if ≥95% of appointment attempts were successful in each general practice was estimated to be 19.6%. This probability reduced to 13.6% when <80% of appointment attempts were successful. This equates to 139 673 fewer GP admissions (456 232 vs 316 559) assuming no change in the total number of admissions. Associations were consistent in direction across geographical regions of England.Conclusions Among hospital inpatients admitted as an emergency, patients
Bottle A, Sanders RD, 2015, The "Friday effect'': Can epidemiology tell us when to operate?, CANADIAN JOURNAL OF ANESTHESIA-JOURNAL CANADIEN D ANESTHESIE, Vol: 62, Pages: 852-856, ISSN: 0832-610X
- Author Web Link
- Cite
- Citations: 2
Aylin PP, Ruiz M, Bottle A, 2015, 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
Ruiz M, Bottle R, Aylin P, 2015, The Global Comparators Project: International comparison of 30-day In-hospital mortality by day of the week, BMJ Quality & Safety, Vol: 24, Pages: 492-504, ISSN: 2044-5423
Objective To examine the association of mortality by day of the week for emergency and elective patients.Design Retrospective observational study using the international dataset from the Global Comparators (GC) project consisting of hospital administrative data.Setting 28 hospitals from England, Australia, USA and the Netherlands during 2009–2012.Participants Emergency and surgical-elective patients.Main outcome measures In-hospital deaths within 30 days of emergency admission or of elective surgery.Results We examined 2 982 570 hospital records; adjusted odds of 30-day death were higher for weekend emergency admissions to 11 hospitals in England (OR 1.08, 95% CI 1.04 to 1.13 on Sunday), 5 hospitals in USA (OR 1.13, 95% CI 1.04 to 1.24 on Sunday) and 6 hospitals in the Netherlands (OR 1.20, 95% CI 1.09 to 1.33 on Saturday). Emergency admissions to the six Australian hospitals showed no daily variation in adjusted 30-day mortality, but showed a weekend effect at 7 days post emergency admission (OR 1.12, 95% CI 1.04 to 1.22 on Saturday). All weekend elective patients showed higher adjusted odds of 30-day postoperative death; we observed a ‘Friday effect’ for elective patients in the six Dutch hospitals.Conclusions We show that mortality outcomes for our sample vary within each country and per day of the week in agreement with previous studies of the ‘weekend effect’. Due to limitations of administrative datasets, we cannot determine the reasons for these findings; however, the international nature of our database suggests that this is a systematic phenomenon affecting healthcare providers across borders. Further investigation is needed to understand the factors that give rise to the weekend effect. The participating hospitals represent varied models of service delivery, and there is a potential to learn from best practice in different healthcare systems.
Cecil E, Bottle A, Sharland M, et al., 2015, Impact of UK primary care policy reforms on short-stay unplanned hospital admissions for children with primary care-sensitive conditions (vol 13, pg 214, 2015), ANNALS OF FAMILY MEDICINE, Vol: 13, Pages: 311-311, ISSN: 1544-1709
Askari A, Nachiappan S, Murphy J, et al., 2015, Colorectal cancer (CRC) patients with inflammatory bowel disease (IBD) are at increased risk of poor outcomes post surgery in england, 2nd Digestive Disorders Federation Conference, Publisher: BMJ Publishing Group, Pages: A326-A326, ISSN: 0017-5749
Askari A, Nachiappan S, Murphy J, et al., 2015, Patients in England with inflammatory bowel disease (IBD) who develop colorectal cancer (CRC) have shortened survival when compared with patients with sporadic CRC, 2nd Digestive Disorders Federation Conference, Publisher: BMJ Publishing Group, Pages: A327-A328, ISSN: 0017-5749
Byrne BE, Aylin P, Bottle A, et al., 2015, PTU-269 Lack of engagement in surgical quality improvement research is associated with poorer quality of care, 2nd Digestive-Disorders-Federation Conference, Publisher: BMJ Publishing Group, Pages: A179-A180, ISSN: 0017-5749
Askari A, Nachiappan S, Currie A, et al., 2015, ELDERLY, ETHNIC MINORITIES AND SOCIALLY DEPRIVED PATIENTS AT HIGH RISK OF REQUIRING EMERGENCY SURGERY FOR COLORECTAL CANCER, 2nd Digestive-Disorders-Federation Conference, Publisher: BMJ PUBLISHING GROUP, Pages: A327-A327, ISSN: 0017-5749
Askari A, Nachiappan S, Currie A, et al., 2015, ELDERLY PATIENTS UNDERGOING LAPAROSCOPIC RESECTION FOR COLORECTAL CANCER HAVE BETTER SURVIVAL THAN PATIENTS UNDERGOING OPEN SURGERY, 2nd Digestive-Disorders-Federation Conference, Publisher: BMJ PUBLISHING GROUP, Pages: A327-A327, ISSN: 0017-5749
Bouras G, Burns EM, Bottle A, et al., 2015, COMBINED EFFECTS OF REOPERATION AND VENOUS THROMBOEMBOLISM IN GASTROINTESTINAL SURGERY: EVALUATION OF POSTOPERATIVE COMPLICATIONS USING LINKED HOSPITAL AND PRIMARY CARE DATA, 2nd Digestive-Disorders-Federation Conference, Publisher: BMJ PUBLISHING GROUP, Pages: A277-A278, ISSN: 0017-5749
Bouras G, Burns EM, Bottle A, et al., 2015, LINKED PRIMARY CARE AND HOSPITAL DATABASE ANALYSIS OF TRENDS IN LAPAROSCOPY, SHORT-TERM COMPLICATIONS AND RECURRENCE FOLLOWING INGUINAL HERNIA REPAIR IN ENGLAND, 2nd Digestive-Disorders-Federation Conference, Publisher: BMJ PUBLISHING GROUP, Pages: A185-A185, ISSN: 0017-5749
Gaudoin R, Montana G, Jones S, et al., 2015, Classifier calibration using splined empirical probabilities in clinical risk prediction, HEALTH CARE MANAGEMENT SCIENCE, Vol: 18, Pages: 156-165, ISSN: 1386-9620
Bouras G, Burns EM, Howell A-M, et al., 2015, LINKED HOSPITAL AND PRIMARY CARE DATABASE STUDY OF VENOUS THROMBOEMBOLISM AND ASSOCIATED MORTALITY FOLLOWING GENERAL SURGICAL PROCEDURES IN ENGLAND, 2nd Digestive-Disorders-Federation Conference, Publisher: BMJ PUBLISHING GROUP, Pages: A44-A45, ISSN: 0017-5749
Cecil E, Bottle A, Sharland M, et al., 2015, Impact of UK primary care policy reforms on short-stay unplanned hospital admissions for children with primary care-sensitive conditions, Annals of Family Medicine, Vol: 13, Pages: 214-220, ISSN: 1544-1709
PURPOSE:We aimed to assess the impact of UK primary care policy reforms implemented in April 2004 on potentially avoidable unplanned short-stay hospital admissions for children with primary care-sensitive conditions.METHODS:We conducted an interrupted time series analysis of hospital admissions for all children aged younger than 15 years in England between April 2000 and March 2012 using data from National Health Service public hospitals in England. The main outcomes were annual short-stay (<2-day) unplanned hospital admission rates for primary care-sensitive infectious and chronic conditions.RESULTS:There were 7.8 million unplanned admissions over the study period. More than one-half (4,144,729 of 7,831,633) were short-stay admissions for potentially avoidable infectious and chronic conditions. The primary care policy reforms of April 2004 were associated with an 8% increase in short-stay admission rates for chronic conditions, equivalent to 8,500 additional admissions, above the 3% annual increasing trend. Policy reforms were not associated with an increase in short-stay admission rates for infectious illness, which were increasing by 5% annually before April 2004. The proportion of primary care-referred admissions was falling before the reforms, and there were further sharp reductions in 2004.CONCLUSIONS:The introduction of primary care policy reforms coincided with an increase in short-stay admission rates for children with primary care-sensitive chronic conditions, and with more children being admitted through emergency departments. Short-stay admission rates for primary care-sensitive infectious illness increased more steadily and could be related to lowered thresholds for hospital admission.
This data is extracted from the Web of Science and reproduced under a licence from Thomson Reuters. You may not copy or re-distribute this data in whole or in part without the written consent of the Science business of Thomson Reuters.