Differences in outcome between patients readmitted to index versus non-index hospital trusts after colorectal resection.

Nepogodiev, Dmitri and Coupland, Ben and Mytton, Jemma and Pinkney, Thomas and Smart, Neil and Bhangu, Aneel (2019) Differences in outcome between patients readmitted to index versus non-index hospital trusts after colorectal resection. Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland. ISSN 1463-1318. This article is available to all UHB staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their UHB Athens login IDs

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Official URL: https://onlinelibrary.wiley.com/doi/abs/10.1111/co...

Abstract

BACKGROUND

The clinical consequences of readmission following major surgery in the English National Health Service is unknown. This study aimed to determine differences in outcome between patients readmitted to index versus non-index trusts after major surgery.

METHODS

Adult patients who underwent colorectal resection in England in April 2006 to March 2017 were identified in the national Hospital Episodes Statistics dataset. Patients were included if they were readmitted as emergencies within 30 days of initial discharge. The primary outcome measure was all-cause mortality within 90-days of readmission. Comparisons between patients readmitted to index versus non-index trusts were adjusted for confounders using multivariable logistic regression. Rectal resection patients were a planned sub-group.

RESULTS

The readmission rate following colorectal resection was 15.1% (54680/364481), with 7.1% (3905/54680) readmitted to a non-index trust. The 90-day mortality following readmission was 7.1% (3874/54680) overall, and 3.9% (652/16736) in the rectal resection sub-group. The reoperation rate was 19.2% (10498/54680) overall, and 23.1% (3859/16736) after rectal resection. Mortality was significantly higher in non-index (10.9% [427/3905]) versus index trusts (6.8% [3447/50775], adjusted odds ratio 1.50, 95% confidence interval 1.34-1.68, p<0.001). There was an annual average of 14.7 excess deaths in non-index trusts; only 1.9 of these followed surgical reoperation. In patients who underwent rectal resection, only 0.3 of the total 1.9 excess deaths each year in non-index trusts followed surgical reoperation.

CONCLUSION

Despite a statistical difference, the absolute number of excess deaths attributable to readmission to a non-index trust is very low, particularly amongst patients requiring reoperation. This article is protected by copyright. All rights reserved.

Item Type: Article
Additional Information: This article is available to all UHB staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their UHB Athens login IDs
Subjects: W Public health. Health statistics. Occupational health. Health education
WI Digestive system. Gastroenterology
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Depositing User: Mrs Yolande Brookes
Date Deposited: 10 May 2019 12:59
Last Modified: 10 May 2019 12:59
URI: http://www.repository.heartofengland.nhs.uk/id/eprint/2084

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