The impact of hospital grade,hospital-volume,and surgeon-volume on outcomes for adults undergoing appendicectomy |
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| Institution: | 1. Department of Surgery, Tel-Aviv Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel;2. Institute of Oncology, Tel-Aviv Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel;1. Hepatobiliary and Pancreatic Surgery Unit, University Hospitals Birmingham, Birmingham, United Kingdom;2. Medical Statistics, University Hospitals Birmingham, Birmingham, United Kingdom;1. Unidad de Cirugía Hepatobiliopancreática, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Guadalajara, Guadalajara, Spain;2. Department of Surgery, Centre Hospitalier du Luxembourg, Luxembourg;1. Department of Surgery, University of Cambridge, Cambridge, UK;2. Human Anatomy Teaching Group, Department of Physiology, Development and Neurosciences, University of Cambridge, Cambridge, UK;1. Trainees'' Committee, Royal College of Surgeons of Edinburgh, Edinburgh, UK;2. Department of Colorectal Surgery, Western General Hospital, Edinburgh, UK;3. Health Education England Yorkshire and the Humber, Leeds, UK;4. Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Oxford, UK;5. Department of Vascular Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK;6. Department of Ear, Nose and Throat Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK;7. Department of Breast Surgery, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK;8. Department of Orthopaedic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK;9. Health Education England North West, Manchester, UK;10. Pfizer Pharma GmbH, Berlin, Germany |
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| Abstract: | IntroductionAcute 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.AimTo establish if hospital grade, hospital-volume, or surgeon-volume impacted patient outcomes following appendicectomy.MethodsUsing 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.ResultsDuring 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).ConclusionPatients 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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| Keywords: | Appendicectomy Hospital-volume Surgeon-volume |
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