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O'Connell RM, Abd Elwahab S, Mealy K. The impact of hospital grade, hospital-volume, and surgeon-volume on outcomes for adults undergoing appendicectomy. Surgeon 2019; 18:280-286. [PMID: 31806483 DOI: 10.1016/j.surge.2019.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 10/21/2019] [Accepted: 10/28/2019] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Acute Appendicitis and appendicectomy are common surgical emergencies worldwide. However, there is a lack of published data on the impact of hospital grade, surgeon- and hospital-volumes on patient outcomes following appendicectomy. AIM To establish if hospital grade, hospital-volume, or surgeon-volume impacted patient outcomes following appendicectomy. METHODS Using the National Quality Assurance and Improvement System (NQAIS) data for all appendicectomies performed in Ireland between January 2014 and November 2017 were examined. Data relating to patient demographics, type of surgery (open/laparoscopic/laparoscopic converted to open), length of stay (LOS), mortality, admission to critical care and re-admission rates were collected and analysed. RESULTS During the study period, 15,896 adult appendicectomies were performed, 14,521 were laparoscopic procedures. Patients treated in district general hospitals (DGHs) had lower LOS (2.96 v 3.37 days, p < 0.0001) than patients treated in tertiary referral hospitals (TRHs), had lower rates of laparoscopic procedures (87.38% v 95.56% p < 0.0001) and higher admission rates to critical care (1.91% v 0.75% p < 0.0001). No significant outcome difference was seen between those treated by high-volume (>62 cases/year) or low volume surgeons (<20 cases/year). Patients treated in high-volume hospitals (>260 cases/year) had higher rates of laparoscopic procedures (94.9% v 83.5%, p < 0.0001), lower rates of admission to critical care (0.85% v 2.25%, p < 0.0001) and lower 7-day re-admission rates (2.54% v 3.55%, p = 0.02) than those operated in low-volume hospitals (<161 cases/year). CONCLUSION Patients operated on in high-volume hospitals benefit from higher rates of laparoscopic surgery and fewer critical care admissions. No significant difference in outcome was noted in those patients operated upon by high- or low-volume surgeons or based on hospital grade.
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Affiliation(s)
- R M O'Connell
- Department of Surgery, Wexford General Hospital, Ireland.
| | - S Abd Elwahab
- Department of Surgery, Wexford General Hospital, Ireland
| | - K Mealy
- Department of Surgery, Wexford General Hospital, Ireland
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Kreindler SA, Siragusa L, Bohm E, Rudnick W, Metge CJ. Regional consolidation of orthopedic surgery: impacts on hip fracture surgery access and outcomes. Can J Surg 2017; 60:349-354. [PMID: 28930037 DOI: 10.1503/cjs.000517] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Timely access to orthopedic trauma surgery is essential for optimal outcomes. Regionalization of some types of surgery has shown positive effects on access, timeliness and outcomes. We investigated how the consolidation of orthopedic surgery in 1 Canadian health region affected patients requiring hip fracture surgery. METHODS We retrieved administrative data on all regional emergency department visits for lower-extremity injury and all linked inpatient stays from January 2010 through March 2013, identifying 1885 hip-fracture surgeries. Statistical process control and interrupted time series analysis controlling for demographics and comorbidities were used to assess impacts on access (receipt of surgery within 48-h benchmark) and surgical outcomes (complications, in-hospital/30-d mortality, length of stay). RESULTS There was a significant increase in the proportion of patients receiving surgery within the benchmark. Complication rates did not change, but there appeared to be some decrease in mortality (significant at 6 mo). Length of stay increased at a hospital that experienced a major increase in patient volume, perhaps reflecting challenges associated with patient flow. CONCLUSION Regionalization appeared to improve the timeliness of surgery and may have reduced mortality. The specific features of the present consolidation (including pre-existing interhospital performance variation and the introduction of daytime slates at the referral hospital) should be considered when interpreting the findings.
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Affiliation(s)
- Sara A Kreindler
- From the Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man. (Kreindler, Bohm, Metge); the George and Fay Yee Centre for Healthcare Innovation, University of Manitoba and Winnipeg Regional Health Authority, Winnipeg, Man. (Kreindler, Bohm, Metge); the College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man. (Siragusa); the Department of Surgery, University of Manitoba and Winnipeg Regional Health Authority, Winnipeg, Man. (Bohm); the Concordia Hip and Knee Institute, Winnipeg Regional Health Authority, Winnipeg, Man. (Bohm); and the St. Boniface Hospital, Winnipeg, Man. (Rudnick)
| | - Lanette Siragusa
- From the Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man. (Kreindler, Bohm, Metge); the George and Fay Yee Centre for Healthcare Innovation, University of Manitoba and Winnipeg Regional Health Authority, Winnipeg, Man. (Kreindler, Bohm, Metge); the College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man. (Siragusa); the Department of Surgery, University of Manitoba and Winnipeg Regional Health Authority, Winnipeg, Man. (Bohm); the Concordia Hip and Knee Institute, Winnipeg Regional Health Authority, Winnipeg, Man. (Bohm); and the St. Boniface Hospital, Winnipeg, Man. (Rudnick)
| | - Eric Bohm
- From the Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man. (Kreindler, Bohm, Metge); the George and Fay Yee Centre for Healthcare Innovation, University of Manitoba and Winnipeg Regional Health Authority, Winnipeg, Man. (Kreindler, Bohm, Metge); the College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man. (Siragusa); the Department of Surgery, University of Manitoba and Winnipeg Regional Health Authority, Winnipeg, Man. (Bohm); the Concordia Hip and Knee Institute, Winnipeg Regional Health Authority, Winnipeg, Man. (Bohm); and the St. Boniface Hospital, Winnipeg, Man. (Rudnick)
| | - Wendy Rudnick
- From the Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man. (Kreindler, Bohm, Metge); the George and Fay Yee Centre for Healthcare Innovation, University of Manitoba and Winnipeg Regional Health Authority, Winnipeg, Man. (Kreindler, Bohm, Metge); the College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man. (Siragusa); the Department of Surgery, University of Manitoba and Winnipeg Regional Health Authority, Winnipeg, Man. (Bohm); the Concordia Hip and Knee Institute, Winnipeg Regional Health Authority, Winnipeg, Man. (Bohm); and the St. Boniface Hospital, Winnipeg, Man. (Rudnick)
| | - Colleen J Metge
- From the Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man. (Kreindler, Bohm, Metge); the George and Fay Yee Centre for Healthcare Innovation, University of Manitoba and Winnipeg Regional Health Authority, Winnipeg, Man. (Kreindler, Bohm, Metge); the College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man. (Siragusa); the Department of Surgery, University of Manitoba and Winnipeg Regional Health Authority, Winnipeg, Man. (Bohm); the Concordia Hip and Knee Institute, Winnipeg Regional Health Authority, Winnipeg, Man. (Bohm); and the St. Boniface Hospital, Winnipeg, Man. (Rudnick)
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Magnitude of non-operative surgical emergency admissions; service implications for surgical and radiological practice. Ir J Med Sci 2016; 186:219-224. [PMID: 27638629 DOI: 10.1007/s11845-016-1496-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 08/28/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Financial sustainability is an area of sharp ongoing focus across the broad spectrum of the Irish Health Service. Recent attention has been drawn to the financial implications of non-operative surgical admissions, suggesting that some of these may be unnecessary. AIMS In this study, we aim to determine the volume of emergency surgical admissions to Mayo University Hospital (MUH), in particular, to identify the scale of non-operative admissions and to assess the wider inherent implications for acute hospital services. METHODS An electronic handover system for emergency surgical admissions was introduced in MUH in September 2014. All surgical admissions from September 1st 2014 to August 31st 2015 were identified from this prospectively maintained database. HIPE (Hospital Inpatient Enquiry) data were not used in this study. Theatre logbooks confirmed those patients who required operative intervention. RESULTS 1466 patients were admitted as emergencies during the study period. 58 % (850) were male and median age was 48 years (0-100). Average length of stay was 5 days (range 1-125). 327 patients (22.3 %) required operative intervention. The most commonly performed procedure was appendicectomy (52.5 %). 48 (3.3 %) patients were transferred to other hospitals. 131 (8.9 %) admissions related to the acute urological conditions. Of the 1466 admissions, 546 underwent a CT scan, while 342 patients proceeded to ultrasound. CONCLUSION Almost 80 % of all surgical emergency admissions were discharged without undergoing a formal operative procedure while generating a significant workload for the radiology department. Changes in working practices and hospital network structures will be required to reduce the burden of non-operative emergency admissions.
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Nason GJ, Baig SN, Burke MJ, Aslam A, Kelly ME, Walsh LG, Flood HD, Giri SK. On-table urethral catheterisation during laparoscopic appendicectomy: Is it necessary? Can Urol Assoc J 2015; 9:55-8. [PMID: 25737758 DOI: 10.5489/cuaj.2341] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Laparoscopic appendicectomy (LA) is the most commonly performed surgical emergency procedure. The aim of this study was to highlight a series of iatrogenic bladder injuries during LA and suggest a simple method of prevention. METHODS A retrospective review was carried out of all LA performed in a university teaching hospital over a two year period 2012-2013. Iatrogenic visceral injuries were identified and operative notes examined. RESULTS During the study period 1124 appendicectomies were performed. Four iatrogenic bladder injuries occurred related to secondary trocar insertion. No patient was catheterised preoperatively. One of the injuries was identified intra-operatively, another in the early postoperative period where as two re-presented acutely unwell post-discharge from hospital. Three were repaired by laparotomy and one laparoscopically. CONCLUSION Iatrogenic secondary trocar induced bladder injuries are a rare but preventable and potentially serious complication of LA. Urethral catheterisation during LA is a safe and simple method which can prevent this complication.
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Affiliation(s)
- Gregory J Nason
- Department of Urology, University Hospital Limerick, Limerick, Ireland
| | | | - Matthew J Burke
- Department of Urology, University Hospital Limerick, Limerick, Ireland
| | - Asadullah Aslam
- Department of Urology, University Hospital Limerick, Limerick, Ireland
| | - Michael E Kelly
- Department of Urology, University Hospital Limerick, Limerick, Ireland
| | - Leon G Walsh
- Department of Urology, University Hospital Limerick, Limerick, Ireland
| | - Hugh D Flood
- Department of Urology, University Hospital Limerick, Limerick, Ireland
| | - Subhasis K Giri
- Department of Urology, University Hospital Limerick, Limerick, Ireland
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