Frequency of surgical treatment and related hospital procedures in the UK: a national ecological study using hospital episode statistics

Abbott, Tom; Fowler, Alexander J.; Dobbs, Tom; Harrison, Ewen M; Gillies, Michael; Pearse, Rupert M

doi:10.1093/bja/aex137

Cited by 179 publications

(185 citation statements)

References 25 publications

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“…To identify procedures that have been performed during the course of a hospital admission, specialist coding staff assign OPCS‐4 codes to that episode of care. Surgery was defined with a total of 1047 OPCS codes ( Table S1, supporting information). This definition of surgery includes procedures that typically require regional or general anaesthesia and excludes procedures such as diagnostic upper gastrointestinal tract endoscopy.…”

Section: Methodsmentioning

confidence: 99%

“…Surgery was defined with a total of 1047 OPCS codes ( Table S1, supporting information). This definition of surgery includes procedures that typically require regional or general anaesthesia and excludes procedures such as diagnostic upper gastrointestinal tract endoscopy. NHS Digital publishes anonymous national summary data annually.…”

Section: Methodsmentioning

confidence: 99%

“…Data sheets for each year were downloaded. Surgical procedures were identified by use of a previously published OPCS‐4‐based definition of surgery. From 1999 to 2011, age data were provided as four age strata (0–14, 15–59, 60–74 and 75 or more years).…”

Section: Methodsmentioning

confidence: 99%

“…More than 5·1 million surgical procedures take place each year in the UK National Health Service (NHS). The deceptively low risk of death at 30 days (1 per cent) conceals a high‐risk population estimated to account for 12·5 per cent of surgical procedures, but 80 per cent of postoperative deaths.…”

Section: Introductionmentioning

confidence: 99%

“…The number of surgical procedures performed in the UK grows at a rate of 1 per cent per annum whilst the average age of the UK population is steadily increasing. Currently, more than half a million people in the UK are aged 90 or more years, with 14 000 centenarians.…”

Section: Introductionmentioning

confidence: 99%

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Age of patients undergoing surgery

Fowler

Abbott

Prowle

et al. 2019

British Journal of Surgery

261

154

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Background Advancing age is independently associated with poor postoperative outcomes. The ageing of the general population is a major concern for healthcare providers. Trends in age were studied among patients undergoing surgery in the National Health Service in England. Methods Time trend ecological analysis was undertaken of Hospital Episode Statistics and Office for National Statistics data for England from 1999 to 2015. The proportion of patients undergoing surgery in different age groupings, their pooled mean age, and change in age profile over time were calculated. Growth in the surgical population was estimated, with associated costs, to the year 2030 by use of linear regression modelling. Results Some 68 205 695 surgical patient episodes (31 220 341 men, 45·8 per cent) were identified. The mean duration of hospital stay was 5·3 days. The surgical population was older than the general population of England; this gap increased over time (1999: 47·5 versus 38·3 years; 2015: 54·2 versus 39·7 years). The number of people aged 75 years or more undergoing surgery increased from 544 998 (14·9 per cent of that age group) in 1999 to 1 012 517 (22·9 per cent) in 2015. By 2030, it is estimated that one‐fifth of the 75 years and older age category will undergo surgery each year (1·49 (95 per cent c.i. 1·43 to 1·55) million people), at a cost of €3·2 (3·1 to 3·5) billion. Conclusion The population having surgery in England is ageing at a faster rate than the general population. Healthcare policies must adapt to ensure that provision of surgical treatments remains safe and sustainable.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Age of patients undergoing surgery

Fowler

Abbott

Prowle

et al. 2019

British Journal of Surgery

261

154

View full text Add to dashboard Cite

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Depth of Anesthesia and Postoperative Delirium

Abbott

Pearse

2019

JAMA

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Evaluation of Textbook Outcome as a Composite Quality Measure of Elective Laparoscopic Cholecystectomy

2022

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ImportanceA textbook outcome (TO) is a composite quality measure that incorporates multiple perioperative events to reflect the most desirable outcome. The use of TO increases the event rate, captures more outcomes to reflect patient experience, and can be used as a benchmark for quality improvement.ObjectivesTo introduce the concept of TO to elective laparoscopic cholecystectomy (LC), propose the TO criteria, and identify characteristics associated with TO failure.Design, Setting, and ParticipantsThis retrospective cohort study was performed at 3 surgical units in a single health board in the United Kingdom. Participants included all patients undergoing elective LC between January 1, 2015, and January 1, 2020. Data were analyzed from January 1, 2015, to January 1, 2020.Main Outcomes and MeasuresThe TO criteria were defined based on review of existing TO metrics in the literature for other surgical procedures. A TO was defined as an unremarkable elective LC without conversion to open cholecystectomy, subtotal cholecystectomy, intraoperative complication, postoperative complications (Clavien-Dindo classification ≥2), postoperative imaging, postoperative intervention, prolonged length of stay (>2 days), readmission within 100 days, or mortality. The rate of TOs was reported. Reasons for TO failure were reported, and preoperative characteristics were compared between TO and TO failure groups using both univariate analysis and multivariable logistic regressions.ResultsA total of 2166 patients underwent elective LC (median age, 54 [range, 13-92] years; 1579 [72.9%] female). One thousand eight hundred fifty-one patients (85.5%) achieved a TO with an unremarkable perioperative course. Reasons for TO failure (315 patients [14.5%]) included conversion to open procedure (25 [7.9%]), subtotal cholecystectomy (59 [18.7%]), intraoperative complications (40 [12.7%]), postoperative complications (Clavien-Dindo classification ≥2; 92 [29.2%]), postoperative imaging (182 [57.8%]), postoperative intervention (57 [18.1%]), prolonged length of stay (>2 days; 142 [45.1%]), readmission (130 [41.3%]), and mortality (1 [0.3%]). Variables associated with TO failure included increasing American Society of Anesthesiologists score (odds ratio [OR], 2.55 [95 CI, 1.69-3.85]; P < .001), increasing number of prior biliary-related admissions (OR, 2.68 [95% CI, 1.36-5.27]; P = .004), acute cholecystitis (OR, 1.42 [95% CI, 1.08-1.85]; P = .01), preoperative endoscopic retrograde cholangiopancreatography (OR, 2.07 [95% CI, 1.46-2.92]; P < .001), and preoperative cholecystostomy (OR, 3.22 [95% CI, 1.54-6.76]; P = .002).Conclusions and RelevanceThese findings suggest that applying the concept of TO to elective LC provides a benchmark to identify suboptimal patterns of care and enables institutions to identify strategies for quality improvement.

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Frequency of surgical treatment and related hospital procedures in the UK: a national ecological study using hospital episode statistics

Abstract: 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.

Cited by 179 publications

References 25 publications

Age of patients undergoing surgery

Age of patients undergoing surgery

Depth of Anesthesia and Postoperative Delirium

Evaluation of Textbook Outcome as a Composite Quality Measure of Elective Laparoscopic Cholecystectomy

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