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A Comparison of Mortality Following Emergency Laparotomy Between Populations From New York State and England

Tan, Benjamin H. L. MD*; Mytton, Jemma BSc; Al-Khyatt, Waleed PhD*; Aquina, Christopher T. MD; Evison, Felicity MSc; Fleming, Fergal J. MD; Griffiths, Ewen MD§; Vohra, Ravinder S. PhD*

doi: 10.1097/SLA.0000000000001964
Original Articles

Objective: The aim of this study was to compare mortality following emergency laparotomy between populations from New York State and England.

Summary of Background Data: Mortality following emergency surgery is a key quality improvement metric in both the United States and UK. Comparison of the all-cause 30-day mortality following emergency laparotomy between populations from New York State and England might identify factors that could improve care.

Methods: Patient demographics, in-hospital, and 30-day outcomes data were extracted from Hospital Episode Statistics (HES) in England and the New York Statewide Planning and Research Cooperative System (SPARCS) administrative databases for all patients older than 18 years undergoing laparotomy for emergency open bowel surgery between April 2009 and March 2014. The primary outcome measure was all-cause mortality within 30 days of the index laparotomy. Mixed-effects logistic regression was performed to model independent demographic variables against mortality. A one-to-one propensity score matched dataset was created to compare the odd ratios of mortality between the 2 populations.

Results: Overall, 137,869 patient records, 85,286 (61.9%) from England and 52,583 (38.1%) from New York State, were extracted. Crude 30-day mortality for patients was significantly higher in the England compared with New York State [11,604 (13.6%) vs 3633 (6.9%) patients, P < 0.001]. Patients undergoing emergency laparotomy in England had significantly higher risk of mortality compared with those in New York State (odds ratio 2.35, confidence interval 2.24–2.46, P < 0.001).

Conclusion: The risk of mortality at 30 days is higher following emergency laparotomy in England as compared with New York State despite similar patient groups.

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*Trent Oesophago-Gastric Unit, City Hospital Campus, Nottingham University Hospitals NHS Trust, Hucknall Road, Nottingham

Department of Health Informatics, University Hospitals Birmingham NHS Foundation Trust, Yardley Court, 11–13 Frederick Road, Edgbaston, Birmingham

Surgical Health Outcomes & Research Enterprise (SHORE), University of Rochester Medical Center. 601 Elmwood Ave, Rochester, NY

§Department of Surgery, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, UK.

Reprints: Ravinder S. Vohra, PhD, Consultant Surgeon, Trent Oesophago-Gastric Unit, City Hospital Campus. Nottingham University Hospitals NHS Trust. Hucknall Road. Nottingham NG5 1PB, UK. E-mail: ravinder.vohra@nuh.nhs.uk.

The authors report no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (www.annalsofsurgery.com).

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