Provision of vascular surgery in England in 2012

Grewal, Perbinder; Davis, Meryl; Hamilton, George

doi:10.1016/j.ejvs.2012.10.017

Cited by 13 publications

(10 citation statements)

References 10 publications

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“…During the study, vascular surgery in Sweden was already carried out by vascular specialist centres. However, in England, pressures to centralize vascular surgery started around 2007, with initial processes starting around 2009 26,27 and further remodelling around 2013 28 . The present study showed that, through increased use of EVAR in England between 2007 and 2012, the difference in 90-day mortality between the two countries was abolished.…”

Section: Discussionmentioning

confidence: 99%

Comparative analysis of the outcomes of elective abdominal aortic aneurysm repair in England and Sweden

Karthikesalingam

Grima

Holt

et al. 2018

British Journal of Surgery

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BackgroundThere is substantial international variation in mortality after abdominal aortic aneurysm (AAA) repair; many non‐operative factors influence risk‐adjusted outcomes. This study compared 90‐day and 5‐year mortality for patients undergoing elective AAA repair in England and Sweden.MethodsPatients were identified from English Hospital Episode Statistics and the Swedish Vascular Registry between 2003 and 2012. Ninety‐day mortality and 5‐year survival were compared after adjustment for age and sex. Separate within‐country analyses were performed to examine the impact of co‐morbidity, hospital teaching status and hospital annual caseload.ResultsThe study included 36 249 patients who had AAA treatment in England, with a median age of 74 (i.q.r. 69–79) years, of whom 87·2 per cent were men. There were 7806 patients treated for AAA in Sweden, with a median of age 73 (68–78) years, of whom 82·9 per cent were men. Ninety‐day mortality rates were poorer in England than in Sweden (5·0 versus 3·9 per cent respectively; P < 0·001), but were not significantly different after 2007. Five‐year survival was poorer in England (70·5 versus 72·8 per cent; P < 0·001). Use of EVAR was initially lower in England, but surpassed that in Sweden after 2010. In both countries, poor outcome was associated with increased age. In England, institutions with higher operative annual volume had lower mortality rates.ConclusionMortality for elective AAA repair was initially poorer in England than Sweden, but improved over time alongside greater uptake of EVAR, and now there is no difference. Centres performing a greater proportion of EVAR procedures achieved better results in England.

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Section: Discussionmentioning

confidence: 99%

Comparative analysis of the outcomes of elective abdominal aortic aneurysm repair in England and Sweden

Karthikesalingam

Grima

Holt

et al. 2018

British Journal of Surgery

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“…For example, one article reported over 800 000 data relating to Clostridium difficile infections. However, this was the answer to a question, rather than obtaining 800 000 individual data points, so was not included in the number of data obtained 5 9. Finally, we had no way of assessing the quality of data collected.…”

Section: Discussionmentioning

confidence: 99%

The UK Freedom of Information Act (2000) in healthcare research: a systematic review

2013

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ObjectivesTo assess the use and utility of the Freedom of Information Act (2000) in healthcare research since 2005 and to determine if any particular feature of studies found led to greater data acquisition.DesignPRISMA compliant systematic review.ParticipantsAn extensive literature search was performed of EMBASE, MEDLINE, CINAHL, psychINFO, BNI, AMED, HMIC and Health business elite databases from January 2005 to January 2013 using terms ‘Freedom of information’, ‘Freedom of information act’ and ‘Freedom of information act 2000’. Papers were considered for publication if they described utilising the UK Freedom of information act to gather data for healthcare research. 16 articles met these criteria.Primary and Secondary outcome measuresPrimary outcome was the number and characteristics of studies utilising the Freedom of Information Act to collect the data for healthcare research. Secondary outcome measures were any features that improved data acquisition rates (including to whom the request was made, the number of questions asked per request, etc.)Results16 articles described utilising the Freedom of Information Act for healthcare research, and these investigated a broad range of topics. The median number of requests made was 86 (range 1–172), the total number of requests was 1732. A total of 15 817 pieces of data were retrieved by all studies. The amount of data collected was defined as the number of questions asked multiplied by the number of full responses. A median of five questions were asked per study (range 5–6.5) and the overall response rate was 86%. The National Health Service litigation authority responded to 100% of requests, while Primary Care Trusts had the lowest response rate of 81% for healthcare bodies. A positive correlation between number of requests made and data obtained (0.508, p<0.05) and number of requests made and increased response rate (0.737, p<0.01), both reached the statistical significance.ConclusionsResearchers should make greater use of the Act to access the information they need that is not otherwise disclosed. We discuss the issues with the research utilising the Act and how future research of this type could be optimised.

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“…Also, during our study period, in particular the years from 2010 to 2015, vascular services in the UK were subject to a process of specialisation away from general surgery, and centralisation from multiple low volume centres to a smaller number of high volume specialist centres. 17 It is possible that this reorganisation of vascular surgical care has had an impact on the changes and improvements identified in the current study. In response to increasing evidence pointing to a positive relationship between hospital and surgeon volumes and the outcome of arterial surgery 18 diagnosis and less complex interventions.…”

Section: Summary Of Main Findingsmentioning

confidence: 95%

“…A hub is a hospital that provides a vascular on-call rota of 1:6 or greater, and serves a population-base of at least 800 000. 17,19 Other possible explanations for the decreasing risks of amputation and death among PAD outcomes (coronary heart disease and stroke) have declined considerably in all UK countries 24,25 . The prevalence of CVD has, however, remained relatively static and slightly increased in men and women aged 65 years and older between 2004 and 2015, which Bhatnagar and colleagues hypothesise could be a result of the reduced mortality and case-fatality rates.…”

Section: Summary Of Main Findingsmentioning

confidence: 99%