Burmas Melinda, Aitken R James, Broughton Katherine J
Department of General Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
ANZ J Surg. 2018 Oct;88(10):998-1002. doi: 10.1111/ans.14847. Epub 2018 Aug 29.
International studies reporting outcomes following emergency laparotomies have consistently demonstrated wide inter-hospital variation and a 30-day mortality in excess of 10%. The UK then prioritized the funding of the National Emergency Laparotomy Audit. In a prospective Western Australian audit there was minimal inter-hospital variation and a 6.6% 30-day mortality. In the absence of any multi-hospital Australian data the aim of the present study was to compare national administrative data with that previously reported.
Data on emergency laparotomies performed in Australian public hospitals during 2013/2014 and 2014/2015 were extracted from admitted patient activity and costing data sets collated by the Independent Hospital Pricing Authority. The data sets, containing episode-level data relating to admitted acute and sub-acute care patients, included administrative, demographic and clinical information such as patient age, cost, length of stay, in-hospital mortality, diagnosis and surgical procedure details.
Ninety-nine public hospitals undertaking at least 50 emergency laparotomies performed 20 388 procedures over the 2 years. The overall in-hospital mortality was 5.2%. There was a wide interstate and inter-hospital variation in risk-adjusted in-hospital mortality (4.8-6.6% and 0-9.3%, respectively), length of stay (12.5-16.8 days and 5.8-18.9 days, respectively) and intensive care unit admissions (24.5-40.2% and 0-75.7%, respectively).
This data suggest the wide variation in outcomes and care process observed overseas exist in Australia. However, administrative data has considerable limitations and is not a substitute for high quality prospective data. Minimizing variations through prospective quality improvement processes will improve patient outcomes.
关于急诊剖腹手术后结果的国际研究一直表明，医院之间存在很大差异，且30天死亡率超过10%。英国随后优先为国家急诊剖腹手术审计提供资金。在一项西澳大利亚州的前瞻性审计中，医院间差异极小，30天死亡率为6.6%。由于缺乏澳大利亚多医院数据，本研究旨在将国家行政数据与先前报告的数据进行比较。
从独立医院定价机构整理的住院患者活动和成本数据集中提取2013/2014年和2014/2015年澳大利亚公立医院进行急诊剖腹手术的数据。这些数据集包含与住院急性和亚急性护理患者相关的病例级数据，包括行政、人口统计学和临床信息，如患者年龄、费用、住院时间、院内死亡率、诊断和手术细节。
在这两年中，99家至少进行50例急诊剖腹手术的公立医院共进行了20388例手术。总体院内死亡率为5.2%。在风险调整后的院内死亡率（分别为4.8 - 6.6%和0 - 9.3%）、住院时间（分别为12.5 - 16.8天和5.8 - 18.9天）以及重症监护病房入院率（分别为24.5 - 40.2%和0 - 75.7%）方面，州与州之间以及医院之间存在很大差异。
这些数据表明，在澳大利亚也存在海外观察到的结果和护理过程的广泛差异。然而，行政数据有相当大的局限性，不能替代高质量的前瞻性数据。通过前瞻性质量改进过程减少差异将改善患者预后。
