Mortality in high-risk emergency general surgical admissions

Area of Science:

• Healthcare research
• Surgical outcomes
• Health services research

Background:

• Evidence suggests inconsistent care standards for emergency general surgery patients within the National Health Service (NHS).
• This study aimed to quantify and investigate variations in mortality rates among high-risk emergency general surgery admissions in English NHS hospital Trusts.

Purpose of the Study:

• To analyze and understand the variability in 30-day mortality for high-risk emergency general surgery patients across English NHS hospital Trusts.
• To identify factors associated with reduced mortality in these patient groups.

Main Methods:

• Utilized the Hospital Episode Statistics (HES) database to identify high-risk emergency general surgery diagnoses (national 30-day mortality >5%).
• Included adult patients admitted to English NHS Trusts between 2000-2009.
• Adjusted 30-day in-hospital mortality for patient and hospital factors, comparing resource availability between high- and low-mortality outlier institutions.

Main Results:

• Included 367,796 patients across 145 hospital Trusts; overall 30-day mortality was 15.6% (range 9.2-18.2%).
• Identified 14 high-mortality and 24 low-mortality outlier Trusts.
• Intensive care/high-dependency beds and increased use of computed tomography (CT) were predictors of reduced mortality (P<0.001).
• Low-mortality Trusts had more intensive care beds (20.8 vs 14.0 per 1000 beds; P=0.017) and greater CT (24.6 vs 17.2 scans/bed/year; P<0.001) and ultrasonography use (42.5 vs 30.2 scans/bed/year; P<0.001).

Conclusions:

• Significant variability in mortality risk exists among hospital Trusts treating high-risk emergency general surgery patients.
• Equitable access to essential hospital resources, such as intensive care beds and advanced imaging, may help reduce outcome disparities.