Department of Surgery, Imperial College, St Mary's Hospital, London W21NY, UK.
BMJ. 2011 Aug 16;343:d4836. doi: 10.1136/bmj.d4836.
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.
Retrospective observational study of Hospital Episode Statistics (HES) data.
HES dataset, an administrative dataset covering the entire English National Health Service.
All patients undergoing a primary colorectal resection in England between 2000 and 2008.
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.
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).
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 indicators such as mortality.
描述择期和急诊结直肠切除术后的全国再次手术率，并评估将再次手术作为源自英国常规收集数据的质量指标的可行性。
医院病例统计（HES）数据的回顾性观察性研究。
HES 数据集，涵盖整个英国国家卫生服务体系的行政数据集。
2000 年至 2008 年间在英格兰接受首次结直肠切除术的所有患者。
结直肠切除术后的再次手术，定义为索引或随后入院后 28 天内对腹部手术或伤口并发症进行的任何再次手术。
全国再次手术率为 6.5%（15986/246469）。各机构和外科医生之间存在很大程度的差异。即使在手术量较大的机构和外科团队中，最高和最低表现信托机构和外科医生之间的再次手术率也相差三倍和五倍。在所研究的国民保健制度信托机构中，14.1%（22/156）的调整后再次手术率高于上限 99.8%的控制限。与更高再手术风险相关的独立因素包括炎症性肠病诊断（比值比 1.33（95%置信区间 1.24 至 1.42），P<0.001）、存在多种合并症（比值比 1.34（1.29 至 1.39），P<0.001）、社会贫困（最贫困者 1.14（1.08 至 1.20），P<0.001）、男性（1.33（1.29 至 1.38），P<0.001）、直肠切除术（1.63（1.56 至 1.71），P<0.001）、腹腔镜手术（1.11（1.03 至 1.20），P=0.006）和紧急入院（1.21（1.17 至 1.26），P<0.001）。
英格兰医院和外科医生之间的结直肠手术后再次手术存在很大差异。如果可以保证数据的准确性，那么与死亡率等其他指标一起，再次手术可以根据国家标准检查当前常规收集数据的绩效。
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