Clinical Safety Research Unit, Department of Surgery and Cancer, School of Public Health, Imperial College London, UK.
Br J Surg. 2013 Sep;100(10):1318-25. doi: 10.1002/bjs.9208. Epub 2013 Jul 17.
There is increasing evidence of variable standards of care for patients undergoing emergency general surgery in the National Health Service (NHS). The aim of this study was to quantify and explore variability in mortality amongst high-risk emergency general surgery admissions to English NHS hospital Trusts.
The Hospital Episode Statistics (HES) database was used to identify high-risk emergency general surgery diagnoses (greater than 5 per cent national 30-day mortality rate). Adults admitted to English NHS Trusts with these diagnoses between 2000 and 2009 were included in the study. Thirty-day in-hospital mortality was adjusted for patient and hospital factors. Trusts were grouped into high- and low-mortality outliers, and resource availability was compared between high- and low-mortality outlier institutions.
Some 367 796 patients admitted to 145 hospital Trusts were included in the study; the 30-day mortality rate was 15·6 per cent (institutional range 9·2-18·2 per cent). Fourteen and 24 hospital Trusts were identified as high- and low-mortality outlier institutions respectively. Intensive care and high-dependency bed resources, as well as greater institutional use of computed tomography (CT), were independent predictors of reduced mortality (P < 0·001). Low-mortality outlying Trusts had significantly more intensive care beds per 1000 hospital beds (20·8 versus 14·0; P = 0·017) and made significantly greater use of CT (24·6 versus 17·2 scans per bed per year; P < 0·001) and ultrasonography (42·5 versus 30·2 scans per bed per year; P < 0·001).
There is significant variability in mortality risk between hospital Trusts treating high-risk emergency general surgery patients. Equitable access to essential hospital resources may reduce variability in outcomes.
英国国家医疗服务体系（NHS）中，接受急诊普通外科手术的患者的护理标准存在差异，这一现象的证据越来越多。本研究的目的是量化并探讨英格兰 NHS 医院信托机构中高危急诊普通外科手术患者的死亡率差异。
利用医院入院统计（HES）数据库，确定高危急诊普通外科诊断（全国 30 天死亡率超过 5%）。纳入 2000 年至 2009 年期间在英格兰 NHS 信托机构接受这些诊断的成年患者。调整患者和医院因素后，计算 30 天院内死亡率。将信托机构分为高死亡率和低死亡率异常值，并比较高死亡率和低死亡率异常值机构之间的资源可用性。
本研究共纳入 145 家医院信托机构的 367796 名患者；30 天死亡率为 15.6%（机构范围 9.2%-18.2%）。有 14 家和 24 家医院信托机构分别被确定为高死亡率和低死亡率异常值机构。重症监护和高依赖床位资源以及更多机构使用计算机断层扫描（CT）是死亡率降低的独立预测因素（P<0.001）。低死亡率异常值信托机构每 1000 张病床拥有的重症监护床位显著更多（20.8 张比 14.0 张；P=0.017），并且更多地使用 CT（每年每床位 24.6 次比 17.2 次；P<0.001）和超声（每年每床位 42.5 次比 30.2 次；P<0.001）。
治疗高危急诊普通外科手术患者的医院信托机构之间的死亡率风险存在显著差异。公平获得基本医院资源可能会降低结果的变异性。
