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Ayyaz FM, Joyner J, Cheetham M, Briggs T, Gray WK. Association of day-case rates with post COVID-19 recovery of elective laparoscopic cholecystectomy activity across England. Ann R Coll Surg Engl 2024. [PMID: 38563060 DOI: 10.1308/rcsann.2023.0111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
INTRODUCTION The aim of this study was to investigate the safety of day-case laparoscopic cholecystectomy, and the association between day-case rates and, post the COVID-19 pandemic, recovery of activity to prepandemic levels for integrated care boards (ICBs) in England. METHODS This was a retrospective observational study of the Hospital Episodes Statistics (HES) data set. Elective laparoscopic cholecystectomies for the period 1 January 2019 to 31 December 2022 were identified. Activity levels for 2022 were compared with those for the whole of 2019 (baseline). Day-case activity was identified where the length of stay recorded in the HES was zero days. RESULTS Data were available for 184,252 patients across the 42 ICBs in England, of which 120,408 (65.3%) were day-case procedures. By December 2022, activity levels for the whole of England had returned to 88.2% of prepandemic levels. The South West region stood out as having recovered activity levels to the greatest extent, with activity at 97.3% of prepandemic levels during 2022. The South West also had the highest postpandemic day-case rate at 74.9% of all patients seen as a day-case during 2022; this compares with an England average of 65.3%. At an ICB level, there was a significant correlation between day-case rates and postpandemic activity levels (r = 0.362, p = 0.019). There was no strong or consistent evidence that day-case surgery had poorer patient outcomes than inpatient surgery. CONCLUSIONS Recovery of elective laparoscopic cholecystectomy activity has been better in South West England than in other regions. Increasing day-case rates may be important if ICBs in other regions are to increase activity levels up to and beyond prepandemic levels.
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Affiliation(s)
- F M Ayyaz
- Getting It Right First Time Programme, NHS England and NHS Improvement, UK
- Manchester University NHS Foundation Trust, UK
| | - J Joyner
- Getting It Right First Time Programme, NHS England and NHS Improvement, UK
- Croydon Health Services NHS Trust, UK
| | - M Cheetham
- Getting It Right First Time Programme, NHS England and NHS Improvement, UK
- The Shrewsbury and Telford Hospital NHS Trust, UK
| | - Twr Briggs
- Getting It Right First Time Programme, NHS England and NHS Improvement, UK
- Royal National Orthopaedic Hospital NHS Trust, UK
| | - W K Gray
- Getting It Right First Time Programme, NHS England and NHS Improvement, UK
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Joyner J, Ayyaz FM, Cheetham M, Briggs TWR, Gray WK. Factors associated with conversion from day-case to in-patient elective inguinal hernia repair surgery across England: an observational study using administrative data. Hernia 2024; 28:555-565. [PMID: 38347244 DOI: 10.1007/s10029-023-02949-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 12/16/2023] [Indexed: 04/06/2024]
Abstract
PURPOSE Elective primary inguinal hernia repair surgery is increasingly being conducted as a day-case procedure. However, some patients planned for day-case surgery have to stay in hospital for at least one night. The aim of this study was to identify the factors associated with conversion from day-case to in-patient management for elective inguinal hernia repair surgery. METHODS This was an exploratory retrospective analysis of observational data from the Hospital Episode Statistics dataset for England. All patients aged ≥ 17 years undergoing a first elective inguinal hernia repair between 1st April 2014 and 31st March 2022 that was planned as day-case surgery were identified. The exposure of interest was discharged on the day of admission (day-case) or requiring overnight stay. The primary outcome of interest was 30-day emergency readmission with an overnight stay. For reporting, providers were aggregated to an Integrated Care Board (ICB) level. RESULTS A total of 351,528 planned day-case elective primary inguinal hernia repairs were identified over the eight-year study period. Of these, 45,305 (12.9%) stayed in hospital for at least one night and were classed as day-case to in-patient stay conversions. Patients who converted to in-patient stay were older, had more comorbidities, and were more likely to have bilateral surgery and be operated on by a low-annual volume surgeon. Post-procedural complications were strongly associated with conversion. Across the 42 ICBs in England, model-adjusted conversion rates varied from 3.3% to 21.3%. CONCLUSIONS There was considerable variation in conversion to in-patient stay rates for inguinal hernia repair across ICBs in England. Our findings should help surgical teams to better identify patients suitable for day-case inguinal hernia repair and plan discharge services more effectively. This should help to reduce the variation in conversion rates.
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Affiliation(s)
- J Joyner
- Getting It Right First Time Programme, NHS England and NHS Improvement, London, UK.
- Department of General Surgery, Croydon Health Services NHS Trust, Croydon University Hospital, 530 London Road, Croydon, CR7 7YE, UK.
| | - F M Ayyaz
- Getting It Right First Time Programme, NHS England and NHS Improvement, London, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | - M Cheetham
- Getting It Right First Time Programme, NHS England and NHS Improvement, London, UK
- Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, UK
| | - T W R Briggs
- Getting It Right First Time Programme, NHS England and NHS Improvement, London, UK
- Royal National Orthopaedic Hospital, London, UK
| | - W K Gray
- Getting It Right First Time Programme, NHS England and NHS Improvement, London, UK
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Kraljevic Z, Bean D, Shek A, Bendayan R, Hemingway H, Yeung JA, Deng A, Baston A, Ross J, Idowu E, Teo JT, Dobson RJB. Foresight-a generative pretrained transformer for modelling of patient timelines using electronic health records: a retrospective modelling study. Lancet Digit Health 2024; 6:e281-e290. [PMID: 38519155 DOI: 10.1016/s2589-7500(24)00025-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 12/20/2023] [Accepted: 02/05/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND An electronic health record (EHR) holds detailed longitudinal information about a patient's health status and general clinical history, a large portion of which is stored as unstructured, free text. Existing approaches to model a patient's trajectory focus mostly on structured data and a subset of single-domain outcomes. This study aims to evaluate the effectiveness of Foresight, a generative transformer in temporal modelling of patient data, integrating both free text and structured formats, to predict a diverse array of future medical outcomes, such as disorders, substances (eg, to do with medicines, allergies, or poisonings), procedures, and findings (eg, relating to observations, judgements, or assessments). METHODS Foresight is a novel transformer-based pipeline that uses named entity recognition and linking tools to convert EHR document text into structured, coded concepts, followed by providing probabilistic forecasts for future medical events, such as disorders, substances, procedures, and findings. The Foresight pipeline has four main components: (1) CogStack (data retrieval and preprocessing); (2) the Medical Concept Annotation Toolkit (structuring of the free-text information from EHRs); (3) Foresight Core (deep-learning model for biomedical concept modelling); and (4) the Foresight web application. We processed the entire free-text portion from three different hospital datasets (King's College Hospital [KCH], South London and Maudsley [SLaM], and the US Medical Information Mart for Intensive Care III [MIMIC-III]), resulting in information from 811 336 patients and covering both physical and mental health institutions. We measured the performance of models using custom metrics derived from precision and recall. FINDINGS Foresight achieved a precision@10 (ie, of 10 forecasted candidates, at least one is correct) of 0·68 (SD 0·0027) for the KCH dataset, 0·76 (0·0032) for the SLaM dataset, and 0·88 (0·0018) for the MIMIC-III dataset, for forecasting the next new disorder in a patient timeline. Foresight also achieved a precision@10 value of 0·80 (0·0013) for the KCH dataset, 0·81 (0·0026) for the SLaM dataset, and 0·91 (0·0011) for the MIMIC-III dataset, for forecasting the next new biomedical concept. In addition, Foresight was validated on 34 synthetic patient timelines by five clinicians and achieved a relevancy of 33 (97% [95% CI 91-100]) of 34 for the top forecasted candidate disorder. As a generative model, Foresight can forecast follow-on biomedical concepts for as many steps as required. INTERPRETATION Foresight is a general-purpose model for biomedical concept modelling that can be used for real-world risk forecasting, virtual trials, and clinical research to study the progression of disorders, to simulate interventions and counterfactuals, and for educational purposes. FUNDING National Health Service Artificial Intelligence Laboratory, National Institute for Health and Care Research Biomedical Research Centre, and Health Data Research UK.
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Affiliation(s)
- Zeljko Kraljevic
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; National Institute for Health and Care Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Dan Bean
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; National Institute for Health and Care Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Anthony Shek
- Department of Neurology, King's College Hospital National Health Service (NHS) Foundation Trust, London, UK; Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Rebecca Bendayan
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; National Institute for Health and Care Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Harry Hemingway
- Health Data Research UK London and Institute of Health Informatics, University College London, London, UK; NIHR Biomedical Research Centre at University College London Hospitals NHS Foundation Trust, London, UK
| | - Joshua Au Yeung
- Department of Neurology, King's College Hospital National Health Service (NHS) Foundation Trust, London, UK; Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Alfred Baston
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jack Ross
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Esther Idowu
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - James T Teo
- Department of Neurology, King's College Hospital National Health Service (NHS) Foundation Trust, London, UK; Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Richard J B Dobson
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Health Data Research UK London and Institute of Health Informatics, University College London, London, UK; National Institute for Health and Care Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK; NIHR Biomedical Research Centre at University College London Hospitals NHS Foundation Trust, London, UK.
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Heyl J, Hardy F, Gray WK, Tucker K, Marchã MJM, Yates J, Briggs TWR, Hutton M. Factors associated with poorer outcomes for posterior lumbar decompression and or/or discectomy: an exploratory analysis of administrative data. Arch Orthop Trauma Surg 2024; 144:1129-1137. [PMID: 38206447 DOI: 10.1007/s00402-023-05182-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 12/11/2023] [Indexed: 01/12/2024]
Abstract
PURPOSE This study aimed to identify factors associated with poorer patient outcomes for lumbar decompression and/or discectomy (PLDD). METHODS We extracted data from the Hospital Episodes Statistics database for the 5 years from 1st April 2014 to 31st March 2019. Patients undergoing an elective one- or two-level PLDD aged ≥ 17 years and without evidence of revision surgery during the index stay were included. The primary patient outcome measure was readmission within 90 days post-discharge. RESULTS Data for 93,813 PLDDs across 111 hospital trusts were analysed. For the primary outcome, greater age [< 40 years vs 70-79 years odds ratio (OR) 1.28 (95% confidence interval (CI) 1.14 to 1.42), < 40 years vs ≥ 80 years OR 2.01 (95% CI 1.76-2.30)], female sex [OR 1.09 (95% CI 1.02-1.16)], surgery over two spinal levels [OR 1.16 (95% CI 1.06-1.26)] and the comorbidities chronic pulmonary disease, connective tissue disease, liver disease, diabetes, hemi/paraplegia, renal disease and cancer were all associated with emergency readmission within 90 days. Other outcomes studied had a similar pattern of associations. CONCLUSIONS A high-throughput PLDD pathway will not be suitable for all patients. Extra care should be taken for patients aged ≥ 70 years, females, patients undergoing surgery over two spinal levels and those with specific comorbidities or generalised frailty.
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Affiliation(s)
- Johannes Heyl
- Department of Physics and Astronomy, University College London, London, UK
- Getting It Right First Time Programme, NHS England, London, UK
| | - Flavien Hardy
- Getting It Right First Time Programme, NHS England, London, UK
| | - William K Gray
- Getting It Right First Time Programme, NHS England, London, UK.
| | - Katie Tucker
- Innovation and Intelligent Automation Unit, Royal Free London NHS Foundation Trust, London, UK
| | - Maria J M Marchã
- Science and Technology Facilities Council Distributed Research Utilising Advanced Computing (DiRAC) High Performance Computing Facility, London, UK
| | - Jeremy Yates
- Science and Technology Facilities Council Distributed Research Utilising Advanced Computing (DiRAC) High Performance Computing Facility, London, UK
- Department of Computer Science, University College London, London, UK
| | - Tim W R Briggs
- Getting It Right First Time Programme, NHS England, London, UK
- Royal National Orthopaedic Hospital, Stanmore, London, UK
| | - Mike Hutton
- Getting It Right First Time Programme, NHS England, London, UK
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
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Joyner J, Ayyaz FM, Cheetham M, Briggs TWR, Gray WK. Day-case and in-patient elective inguinal hernia repair surgery across England: an observational study of variation and outcomes. Hernia 2023; 27:1439-1449. [PMID: 37851291 DOI: 10.1007/s10029-023-02893-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 09/13/2023] [Indexed: 10/19/2023]
Abstract
PURPOSE Elective primary inguinal hernia repair surgery is increasingly being conducted as a day-case procedure. However, in England there is evidence of wide variation in day-case rates across hospitals. Reducing the extent of this variation has the potential to support more efficient use of resources (e.g., clinician time, hospital beds) and help the recovery of elective surgical activity following the COVID-19 pandemic. The aims of this study were to explore the extent of variation in day-case rates across healthcare providers in England and to evaluate the safety of day-case elective primary inguinal hernia repair surgery. METHODS This was an exploratory, retrospective analysis of observational data from the Hospital Episode Statistics data set for England. All patients aged ≥ 17 years undergoing a first elective inguinal hernia repair between 1st April 2014 and 31st March 2022 were identified. The exposure of interest was day-case or in-patient stay, and the primary outcome of interest was 30-day emergency readmission with an overnight stay. For reporting, providers were aggregated to an Integrated Care Board (ICB) level. RESULTS A total of 413,059 elective primary inguinal hernia repairs were identified over the 8-year study period. Of these, 326,833 (79.1%) were day-case procedures. During the most recent financial year (2021-22), the highest day-case rate for an ICB was 93.8% and the lowest 66.1%. After adjusting for covariates, day-case surgery was associated with significantly lower rates of 30-day emergency readmission (odds ratio (OR) 0.61, 95% confidence interval (CI) 0.58-0.64, p < 0.001) and for the secondary outcomes 180-day mortality and haemorrhage, infection and pain at 30-day post-discharge. Rates of 30-day emergency readmission were significantly lower in ICBs with high rates of day-case surgery (OR 0.84, 95% CI 0.74-0.96, p < 0.001) than in ICBs with low rates of day-case surgery, although rates of post-procedural haemorrhage within 30 days of discharge were significantly higher in trusts with high day-case rates (OR 1.20, 95% CI 1.04-1.40, p = 0.015). CONCLUSIONS For the outcomes studied, we found no consistent evidence that day-case elective inguinal hernia repair was unsafe for selected patients. Currently, there is substantial variation between ICBs in terms of delivering day-case surgery. Reducing this variability may help address the current pressures on the NHS in elective surgery.
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Affiliation(s)
- J Joyner
- Getting It Right First Time Programme, NHS England, London, UK.
- Croydon Health Services NHS Trust, Croydon, UK.
- Department of General Surgery, Croydon University Hospital, Croydon Health Services NHS Trust, 530 London Road, Croydon, CR7 7YE, UK.
| | - F M Ayyaz
- Getting It Right First Time Programme, NHS England, London, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | - M Cheetham
- Getting It Right First Time Programme, NHS England, London, UK
- Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, UK
| | - T W R Briggs
- Getting It Right First Time Programme, NHS England, London, UK
- Royal National Orthopaedic Hospital, London, UK
| | - W K Gray
- Getting It Right First Time Programme, NHS England, London, UK
- Royal National Orthopaedic Hospital, London, UK
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Naser AY, Alshehri H. Paediatric hospitalisation related to medications administration errors of non-opioid analgesics, antipyretics and antirheumatics in England and Wales: a longitudinal ecological study. BMJ Open 2023; 13:e080503. [PMID: 38000821 PMCID: PMC10680006 DOI: 10.1136/bmjopen-2023-080503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 11/13/2023] [Indexed: 11/26/2023] Open
Abstract
OBJECTIVE This study aimed to explore paediatric hospitalisation related to medication administration errors (MAEs) of non-opioid analgesics, antipyretics and antirheumatics in England and Wales. DESIGN An ecological study. SETTING A population-based study on hospitalised patients in England and Wales. Hospital admission data were extracted from the Hospital Episode Statistics database in England and the Patient Episode Database for Wales for the period between April 1999 and April 2020. Admissions cause was confirmed using the diagnostic codes T39.0-T39.9. PARTICIPANTS Paediatric patients aged 15 years and below who were hospitalised at all National Health Service (NHS) trusts and any independent sector funded by NHS trusts. PRIMARY OUTCOME MEASURE Hospitalisation rates related to MAEs of non-opioid analgesics, antipyretics and antirheumatics. RESULTS The yearly number of admissions for MAEs associated with non-opioid analgesics, antipyretics and antirheumatics experienced a notable growth of 21.7% over the span of two decades, rising from 4574 cases in 1999 to 5568 cases in 2020. The observed increase demonstrates a significant upward trend in hospital admissions rate, with a 12.3% growth from 46.16 per 100 000 individuals in 1999 to 51.83 per 100 000 individuals in 2020 (95% CIs 44.83 to 47.50 and 50.47 to53.19, respectively, trend test, p<0.05). The therapeutic categories that exhibited the highest frequency of MAEs were '4-aminophenol derivatives' and 'other non-steroidal anti-inflammatory drugs', accounting for 79.3% and 16.0% of cases, respectively. It is worth noting that there was a significant increase of 28.9% in hospitalisations linked to MAEs specifically associated with '4-aminophenol derivatives.' CONCLUSION The research revealed a notable rise in the overall yearly number of hospital admissions associated with MAEs within the paediatric population. This study emphasises the necessity for additional research aimed at mitigating the potential hazards associated with the ingestion of these medications, particularly within susceptible demographics, such as young children.
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Affiliation(s)
- Abdallah Y Naser
- Department of Applied Pharmaceutical Sciences and Clinical Pharmacy, Isra University, Amman, Jordan
| | - Hassan Alshehri
- Department of Pediatrics, College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, UK
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Boasman A, Jones M, Dyer P, Briggs TWR, Gray WK. The association of demographics, frailty and multiple health conditions with outcomes from acute medical admissions to hospitals in England: exploratory analysis of an administrative dataset. Future Healthc J 2023; 10:278-286. [PMID: 38162202 PMCID: PMC10753216 DOI: 10.7861/fhj.2023-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Emergency and acute hospital services in England are under increasing pressure. The aim of this study was to investigate the association between key case-mix indicators and outcomes for adults admitted to hospital with an acute medical condition in England. All patients aged ≥16 years admitted to hospital in England as an acute unselected medical admission and who survived to discharge during the financial year 2021-2022 were included. Length of hospital stay was the primary outcome of interest. Data were available for 1,586,168 unique patients. A case-mix index was developed with a score that ranged from 0 to 12. Frailty was the most important variable in the index, followed by multiple health conditions and patient age. The mean case-mix score across hospital trusts in England ranged from 5.3 to 7.8. The case-mix index will support initiatives to better understand factors contributing to outcomes from acute medical admissions to hospital.
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Affiliation(s)
- Andrew Boasman
- Getting It Right First Time Programme, NHS England, London, UK
| | - Michael Jones
- Getting It Right First Time Programme, NHS England, London, UK, and consultant physician in acute medicine, County Durham and Darlington NHS Foundation Trust, Durham, UK
| | - Philip Dyer
- Getting It Right First Time Programme, NHS England, London, UK and consultant physician in general medicine, diabetes and endocrinology, Heartlands Hospital, Birmingham, UK
| | - Tim WR Briggs
- Getting It Right First Time Programme and NHS England national director for clinical improvement and elective recovery, NHS England, London, UK
| | - William K Gray
- Getting It Right First Time programme, NHS England, London, UK
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Ojelade E, Koris J, Van-Hove M, Gray WK, Briggs TWR, Hutton M. Trends Over Time in the Use, Carbon Footprint and Costs of Facet Joint Injections and Medial Branch Blocks to Manage Lumbar Pain in England: Retrospective Analysis of an Administrative Dataset. Global Spine J 2023:21925682231203651. [PMID: 37791603 DOI: 10.1177/21925682231203651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/05/2023] Open
Abstract
STUDY DESIGN Retrospective analysis of an administrative dataset. OBJECTIVE This study aims to investigate changing practice over a six-year period in the use of repeated lumbar facet joint injections/medial branch blocks in England. METHODS Patient data were extracted from the Hospital Episodes Statistics database for the period 1st April 2015 to 31st March 2021 for the index lumbar injection and for repeat lumbar injections performed within one year of the first. The exposure of interest was two injections within 180 days or three within one year. Patients aged <17 years and where the body site was listed as cervical, thoracic or sacral were excluded. RESULTS Data were available for 134,249 patients of which, 8,922 (6.6%) had either two injections within 180 days or three injections within one year. First injections fell from 42,511 in 2015/16 to 13,368 in 2019/20 as did the number of repeat injections: 4,018 to 424 for the same period. If all years had the same carbon footprint as 2019/20, 2.8 kilotons of CO2e would have been saved over the five years, enough to power 2,575 average UK homes for 1 year. The financial cost of injections decreased from £27.6 million in 2015/16 to £7.9 million in 2019/20. CONCLUSIONS The number of patients having repeated lumbar injections has decreased over time but has not been eliminated. More work is needed to educate patients and clinicians regarding alternative and more effective treatments.
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Affiliation(s)
- Elizabeth Ojelade
- Getting It Right First Time Programme, NHS England, London, UK
- Orthopaedic Surgery, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Jacob Koris
- Getting It Right First Time Programme, NHS England, London, UK
- FMLM National Medical Director's Clinical Fellow, NHS England, London, UK
- Orthopaedic Surgery, John Radcliffe Hospital, Oxford, UK
| | - Maria Van-Hove
- Getting It Right First Time Programme, NHS England, London, UK
- Clinical Fellow, NHS England, London, UK
| | - William K Gray
- Getting It Right First Time Programme, NHS England, London, UK
| | - Tim W R Briggs
- Getting It Right First Time Programme, NHS England, London, UK
- Orthopaedic Surgery, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Mike Hutton
- Getting It Right First Time Programme, NHS England, London, UK
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Goldman S, Saoulidi A, Kalidindi S, Kravariti E, Gaughran F, Briggs TWR, Gray WK. Comparison of outcomes for patients with and without a serious mental illness presenting to hospital for chronic obstruction pulmonary disease: retrospective observational study using administrative data. BJPsych Open 2023; 9:e128. [PMID: 37458249 PMCID: PMC10375884 DOI: 10.1192/bjo.2023.522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND There are few data on the profile of those with serious mental illness (SMI) admitted to hospital for physical health reasons. AIMS To compare outcomes for patients with and without an SMI admitted to hospital in England where the primary reason for admission was chronic obstructive pulmonary disease (COPD). METHOD This was a retrospective, observational analysis of the English Hospital Episodes Statistics data-set for the period from 1 April 2018 to 31 March 2019, for patients aged 18-74 years with COPD as the dominant reason for admission. Patient with an SMI (psychosis spectrum disorder, bipolar disorder) were identified. RESULTS Data were available for 54 578 patients, of whom 2096 (3.8%) had an SMI. Patients with an SMI were younger, more likely to be female and more likely to live in deprived areas than those without an SMI. The burden of comorbidity was similar between the two groups. After adjusting for covariates, SMI was associated with significantly greater risk of length of stay than the median (odds ratio 1.24, 95% CI 1.12-1.37, P ≤ 0.001) and with 30-day emergency readmission (odds ratio 1.51, 95% confidence interval 1.34-1.69, P ≤ 0.001) but not with in-hospital mortality. CONCLUSION Clinicians should be aware of the potential for poorer outcomes in patients with an SMI even when the SMI is not the primary reason for admission. Collaborative working across mental and physical healthcare provision may facilitate improved outcomes for people with SMI.
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Affiliation(s)
- Sara Goldman
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Anastasia Saoulidi
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Sridevi Kalidindi
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Getting It Right First Time Programme, NHS England, London, UK; and South London and Maudsley NHS Foundation Trust, London, UK
| | - Eugenia Kravariti
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Fiona Gaughran
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; and South London and Maudsley NHS Foundation Trust, London, UK
| | - Tim W R Briggs
- Getting It Right First Time Programme, NHS England, London, UK; and Department of Surgery, Royal National Orthopaedic Hospital, Stanmore, London, UK
| | - William K Gray
- Getting It Right First Time Programme, NHS England, London, UK
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Gray WK, Navaratnam AV, Rennie C, Mendoza N, Briggs TWR, Phillips N. The volume-outcome relationship for endoscopic transsphenoidal pituitary surgery for benign neoplasm: analysis of an administrative dataset for England. Br J Neurosurg 2023:1-8. [PMID: 36740733 DOI: 10.1080/02688697.2023.2175783] [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: 09/26/2022] [Revised: 01/23/2023] [Accepted: 01/28/2023] [Indexed: 02/07/2023]
Abstract
BACKGROUND Setting minimum annual volume thresholds for pituitary surgery in England is seen as one way of improving outcomes for patients and service efficiency. However, there are few recent studies from the UK on whether a volume-outcome effect exists, particularly in the era of endoscopic surgery. Such data are needed to allow evidence-based decision making. The aim of this study was to use administrative data to investigate volume-outcome effects for endoscopic transsphenoidal pituitary surgery in England. METHODS Data from the Hospital Episodes Statistics database for adult endoscopic transsphenoidal pituitary surgery for benign neoplasm conducted in England from April 2013 to March 2019 (inclusive) were extracted. Annual surgeon and trust volume was defined as the number of procedures conducted in the 12 months prior to the index procedure. Volume was categorised as < 10, 10-19, 20-29, 30-39 and ≥40 procedures for surgeon volume and < 20, 20-39, 40-59, 60-79 and ≥80 procedures for trust volume. The primary outcome was repeat ETSPS during the index procedure or during a hospital admission within one-year of discharge from the index procedure. RESULTS Data were available for 4590 endoscopic transsphenoidal pituitary procedures. After adjustment for covariates, higher surgeon volume was significantly associated with reduced risk of repeat surgery within one year (odds ratio (OR) 0.991 (95% confidence interval (CI) 0.982-1.000)), post-procedural haemorrhage (OR 0.977 (95% CI 0.967-0.987)) and length of stay greater than the median (0.716 (0.597-0.859)). A higher trust volume was associated with reduced risk of post-procedural haemorrhage (OR 0.992 (95% CI 0.985-0.999)), but with none of the other patient outcomes studied. CONCLUSIONS A surgeon volume-outcome relationship exists for endoscopic transsphenoidal pituitary surgery in England.
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Affiliation(s)
| | - Annakan V Navaratnam
- NHS England and NHS Improvement, London, UK
- Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Catherine Rennie
- Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Nigel Mendoza
- Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | | | - Nick Phillips
- NHS England and NHS Improvement, London, UK
- Leeds General Infirmary, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
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