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Journal articleBottle A, Jarman B, Aylin P, 2011,
Strengths and weaknesses of hospital standardised mortality ratios.
, BMJ: British Medical Journal, Vol: 342 -
Journal articleBurns EM, Rigby E, Mamidanna R, et al., 2011,
Systematic review of discharge coding accuracy
, ISSN: 1741-3850Introduction Routinely collected data sets are increasingly used for research, financial reimbursement and health service planning. High quality data are necessary for reliable analysis. This study aims to assess the published accuracy of routinely collected data sets in Great Britain. METHODS: Systematic searches of the EMBASE, PUBMED, OVID and Cochrane databases were performed from 1989 to present using defined search terms. Included studies were those that compared routinely collected data sets with case or operative note review and those that compared routinely collected data with clinical registries. RESULTS: Thirty-two studies were included. Twenty-five studies compared routinely collected data with case or operation notes. Seven studies compared routinely collected data with clinical registries. The overall median accuracy (routinely collected data sets versus case notes) was 83.2% (IQR: 67.3-92.1%). The median diagnostic accuracy was 80.3% (IQR: 63.3-94.1%) with a median procedure accuracy of 84.2% (IQR: 68.7-88.7%). There was considerable variation in accuracy rates between studies (50.5-97.8%). Since the 2002 introduction of Payment by Results, accuracy has improved in some respects, for example primary diagnoses accuracy has improved from 73.8% (IQR: 59.3-92.1%) to 96.0% (IQR: 89.3-96.3), P= 0.020. CONCLUSION: Accuracy rates are improving. Current levels of reported accuracy suggest that routinely collected data are sufficiently robust to support their use for research and managerial decision-making.
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Journal articleBurns EM, Bottle A, Aylin P, et al., 2011,
Variation in reoperation after colorectal surgery in England as an indicator of surgical performance: retrospective analysis of Hospital Episode Statistics
, Vol: 343, ISSN: 1468-5833OBJECTIVE: To describe national reoperation rates after elective and emergency colorectal resection and to assess the feasibility of using reoperation as a quality indicator derived from routinely collected data in England. DESIGN: Retrospective observational study of Hospital Episode Statistics (HES) data. SETTING: HES dataset, an administrative dataset covering the entire English National Health Service. PARTICIPANTS: All patients undergoing a primary colorectal resection in England between 2000 and 2008. MAIN OUTCOME MEASURES: Reoperation after colorectal resection, defined as any reoperation for an intra-abdominal procedure or wound complication within 28 days of surgery on the index or subsequent admission to hospital. RESULTS: The national reoperation rate was 6.5% (15,986/246,469). A large degree of variation was identified among institutions and surgeons. Even among institutions and surgical teams with high caseloads, threefold and fivefold differences in reoperation rates were observed between the highest and lowest performing trusts and surgeons. Of the NHS trusts studied, 14.1% (22/156) had adjusted reoperation rates above the upper 99.8% control limit. Factors independently associated with higher risk of reoperation were diagnosis of inflammatory bowel disease (odds ratio 1.33 (95% CI 1.24 to 1.42), P<0.001), presence of multiple comorbidity (odds ratio 1.34 (1.29 to 1.39), P<0.001), social deprivation (1.14 (1.08 to 1.20) for most deprived, P<0.001), male sex (1.33 (1.29 to 1.38), P<0.001), rectal resection (1.63 (1.56 to 1.71), P<0.001), laparoscopic surgery (1.11 (1.03 to 1.20), P = 0.006), and emergency admission (1.21 (1.17 to 1.26), P<0.001). CONCLUSIONS: There is large variation in reoperation after colorectal surgery between hospitals and surgeons in England. If data accuracy can be assured, reoperation may allow performance to be checked against national standards from current routinely collected data, alongside other indicator
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Journal articleAlmoudaris AM, Burns EM, Mamidanna R, et al., 2011,
Value of failure to rescue as a marker of the standard of care following reoperation for complications after colorectal resection
, The British journal of surgery, Vol: 98, Pages: 1775-1783, ISSN: 1365-2168BACKGROUND: Complication management appears to be of vital importance to differences in survival following surgery between surgical units. Failure-to-rescue (FTR) rates have not yet distinguished surgical from general medical complications. The aim of this study was to assess whether variability exists in FTR rates after reoperation for serious surgical complications following colorectal cancer resections in England. METHODS: The Hospital Episode Statistics (HES) database was used to identify patients undergoing primary resection for colorectal cancer between 2000 and 2008 in English National Health Service (NHS) trusts. Units were ranked into quintiles according to overall risk-adjusted mortality. Highest and lowest mortality quintiles were compared with respect to reoperation rates and FTR-surgical (FTR-S) rates. FTR-S was defined as the proportion of patients with an unplanned reoperation who died within the same admission. RESULTS: Some 144 542 patients undergoing resection for colorectal cancer in 150 English NHS trusts were included. On ranking according to risk-adjusted mortality, rates varied significantly between lowest and highest mortality quintiles (5.4 and 9.3 per cent respectively; P = 0.029). Lowest and highest mortality quintiles had equivalent adjusted reoperation rates (both 4.8 per cent; P = 0.211). FTR-S rates were significantly higher at units within the worst mortality quintile (16.8 versus 11.1 per cent; P = 0.002). CONCLUSION: FTR-S rates differed significantly between English colorectal units, highlighting variability in ability to prevent death in this high-risk group. This variability may represent differences in serious surgical complication management. FTR-S represents a readily collectable marker of surgical complication management that is likely to be applicable to other surgical specialties. Copyright (c) 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
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Journal articleMamidanna R, Burns EM, Bottle A, et al., 2011,
Reduced Risk of Medical Morbidity and Mortality in Patients Selected for Laparoscopic Colorectal Resection in England: A Population-Based Study
, ISSN: 1538-3644OBJECTIVES: To quantify the occurrence of significant medical complications following elective colorectal resection and investigate potential differences in medical morbidity following open and minimal access colorectal surgery. DESIGN: Retrospective analysis of Hospital Episode Statistics, which is a prospectively maintained national database. SETTING: All patients undergoing colorectal resection in National Health Service trusts in England. PATIENTS: Adult patients undergoing elective or planned surgery between April 2001 and March 2008. INTERVENTION: Colorectal resection for benign and malignant diagnoses. MAIN OUTCOME MEASURES: Mortality and morbidity at 30 days and 1 year following elective colorectal resection. RESULTS: One hundred thirty-eight thousand seven hundred thirty-five elective colorectal resections were identified between the study dates. Thirty-day in-hospital mortality was 3.4% and 1.7% following conventional and laparoscopic surgery, respectively (P < .001). Overall, the 30-day postoperative medical morbidity rate was 14.6%. Use of the minimal access approach demonstrated a significant reduction in total morbidity risk at 30 days (odds ratio, 0.79; P < .001) and 365 days (odds ratio, 0.81; P < .001) following case-mix adjustment. Multiple regression analyses demonstrated that cardiorespiratory complications and venous thromboembolism occurred less frequently during the index admission and up to 1 year following minimal access surgery when compared with the conventional approach (P < .049). CONCLUSIONS: In this population-based study, patients selected for laparoscopic colorectal resection were associated with lower risk of mortality as well as reduced cardiorespiratory and venous thromboembolic risk than those undergoing open surgery.
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Journal articleBurns EM, Naseem H, Bottle A, et al., 2010,
Introduction of laparoscopic bariatric surgery in England: observational population cohort study
, BMJ-BRITISH MEDICAL JOURNAL, Vol: 341, ISSN: 1756-1833- Author Web Link
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- Citations: 60
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Journal articleLazzarino AI, Nagpal K, Bottle A, et al., 2010,
Open Versus Minimally Invasive Esophagectomy <i>Trends of Utilization and Associated Outcomes in England</i>
, ANNALS OF SURGERY, Vol: 252, Pages: 292-298, ISSN: 0003-4932- Author Web Link
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- Citations: 87
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Journal articleAylin P, Yunus A, Bottle A, et al., 2010,
Weekend mortality for emergency admissions. A large, multicentre study
, QUALITY & SAFETY IN HEALTH CARE, Vol: 19, Pages: 213-217, ISSN: 1475-3898- Author Web Link
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- Citations: 191
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Journal articleWu T-Y, Jen M-H, Bottle A, et al., 2010,
Ten-year trends in hospital admissions for adverse drug reactions in England 1999-2009
, JOURNAL OF THE ROYAL SOCIETY OF MEDICINE, Vol: 103, Pages: 239-250, ISSN: 0141-0768- Author Web Link
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- Citations: 110
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Journal articleJarman B, Aylin P, Bottle A, 2010,
<i>Hospital mortality ratios</i> A plea for reason
, BRITISH MEDICAL JOURNAL, Vol: 340, ISSN: 0959-535X- Author Web Link
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- Citations: 2
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