William Harvey Research Institute, Queen Mary University of London, EC1M 6BQ, UK.
Guys and St Thomas' NHS Foundation Trust, SE1 7EH, UK.
Br J Anaesth. 2017 Aug 1;119(2):249-257. doi: 10.1093/bja/aex137.
Despite evidence of high activity, the number of surgical procedures performed in UK hospitals, their cost and subsequent mortality remain unclear.
Time-trend ecological study using hospital episode data from England, Scotland, Wales and Northern Ireland. The primary outcome was the number of in-hospital procedures, grouped using three increasingly specific categories of surgery. Secondary outcomes were all-cause mortality, length of hospital stay and healthcare costs according to standard National Health Service tariffs.
Between April 1, 2009 and March 31, 2014, 39 631 801 surgical patient episodes were recorded. There was an annual average of 7 926 360 procedures (inclusive category), 5 104 165 procedures (intermediate category) and 1 526 421 procedures (restrictive category). This equates to 12 537, 8073 and 2414 procedures per 100 000 population per year, respectively. On average there were 85 181 deaths (1.1%) within 30 days of a procedure each year, rising to 178 040 deaths (2.3%) after 90 days. Approximately 62.8% of all procedures were day cases. Median length of stay for in-patient procedures was 1.7 (1.3-2.0) days. The total cost of surgery over the 5 yr period was £54.6 billion ($104.4 billion), representing an average annual cost of £10.9 billion (inclusive), £9.5 billion (intermediate) and £5.6 billion (restrictive). For each category, the number of procedures increased each year, while mortality decreased. One-third of all mortalities in national death registers occurred within 90 days of a procedure (inclusive category).
The number of surgical procedures in the UK varies widely according to definition. The number of procedures is slowly increasing whilst the number of deaths is decreasing.
尽管有大量的证据表明手术非常活跃，但英国医院的手术数量、手术成本及其后续死亡率仍不清楚。
采用英格兰、苏格兰、威尔士和北爱尔兰的医院住院数据进行时间趋势的生态学研究。主要结局是手术数量，根据手术的三个日益具体的类别进行分组。次要结局是根据国家卫生服务标准费率计算的全因死亡率、住院时间和医疗保健成本。
在 2009 年 4 月 1 日至 2014 年 3 月 31 日期间，记录了 39631801 例手术患者住院病例。每年平均有 7926360 例手术（包括类）、5104165 例手术（中级类）和 1526421 例手术（限制类）。这相当于每年每 10 万人中有 12537、8073 和 2414 例手术。平均每年有 85181 例（1.1%）患者在手术后 30 天内死亡，90 天后上升至 178040 例（2.3%）。大约 62.8%的手术为日间手术。住院手术的中位住院时间为 1.7（1.3-2.0）天。在 5 年期间，手术总成本为 546 亿英镑（1044 亿美元），平均每年成本为 109 亿英镑（包括类）、95 亿英镑（中级类）和 56 亿英镑（限制类）。每个类别中，每年的手术数量都在增加，而死亡率则在下降。国家死亡登记处三分之一的死亡发生在手术后 90 天内（包括类）。
英国的手术数量根据定义而有很大差异。手术数量在缓慢增加，而死亡人数在减少。国家死亡登记处三分之一的死亡发生在手术后 90 天内（包括类）。
