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01-10-2015 | Original

Regional variation in critical care provision and outcome after high-risk surgery

Authors: Michael A. Gillies, G. Sarah Power, David A. Harrison, Andrew Fleming, Brian Cook, Timothy S. Walsh, Rupert M. Pearse, Kathryn M. Rowan

Published in: Intensive Care Medicine | Issue 10/2015

Abstract

Purpose

Evidence of variation in mortality after surgery may indicate preventable postoperative death. We sought to determine if regional differences in outcome were present in surgical patients admitted to critical care in the UK.

Methods

We extracted data on admission characteristics, case mix and outcome of all patients admitted to UK critical care units following surgery for the calendar year of 2009. We also used publicly held data on regional population, volume of surgery and bed provision. Multilevel regression analysis was used to adjust for the effects of case mix and regional critical care bed provision on acute hospital mortality.

Results

A total of 16,147 patients admitted to critical care following surgery were included in this analysis. Median odds ratio (MOR) was used to describe regional-level variance in acute hospital mortality. Significant variation was identified (MOR 1.14; 95 % CI 1.07, 1.28) and persisted following adjustment for case mix (MOR 1.10; 95 % CI 1.04, 1.25) and regional critical care bed provision (MOR 1.09; 95 % CI 1.04, 1.24). Critical care bed utilisation (surgical critical care admissions per 100,000 surgical procedures) seemed to better explain this observation (MOR 1.03; 95 % CI 1.00, 29.26) and was associated with statistically significant reduction in mortality (OR 0.91; 95 % CI 0.85, 0.97; p = 0.01).

Conclusion

Significant regional variation in hospital mortality for patients admitted to critical care following surgery was observed. Critical care bed utilisation seemed to better explain this observation and was associated with improved outcome.

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Title: Regional variation in critical care provision and outcome after high-risk surgery
Authors: Michael A. Gillies
G. Sarah Power
David A. Harrison
Andrew Fleming
Brian Cook
Timothy S. Walsh
Rupert M. Pearse
Kathryn M. Rowan
Publication date: 01-10-2015
Publisher: Springer Berlin Heidelberg
Published in: Intensive Care Medicine / Issue 10/2015
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-015-3980-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Regional variation in critical care provision and outcome after high-risk surgery

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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