Geographic Influences on Emergency Laparotomy Outcomes
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 40,000
- 试验地点
- 1
- 主要终点
- Mortality
研究概览
简要总结
Introduction
'Emergency Laparotomy' is an umbrella term for a set of commonly performed procedures which are known to carry a significant risk of mortality and morbidity. Previous work has shown considerable inter-hospital variation in emergency laparotomy outcomes within the United Kingdom. It is unknown whether there are significant differences in outcomes following laparotomy which may be explained by geographic factors.
Aims
The aim of this study is to describe emergency laparotomy outcomes in Scotland as they vary by the urban-rural nature of the patient's home location and travel time from hospital.
Methods
This research study is a retrospective observational enquiry which will utilise administrative data from the Information Services Division (ISD) of NHS National Services Scotland. Patient episodes will be identified by a set of procedure codes for emergency laparotomy, and the urban-rural classification of patients will be derived from postcode data. Travel time from hospital will also be derived from postcode data. The investigators will study a 10 year period from January 2001 to December 2010.
The primary outcome measure will be risk-adjusted 30 day/inpatient mortality, and secondary outcome measures will be 30 day readmission rate, 30 day re-operation rate and post-operative length of stay.
详细描述
The aim of this study is to explore the possibility that outcomes from emergency laparotomy may vary according to:
- the urban-rural nature of the patient's home location and
- travel time from hospital.
This is a retrospective study of all emergency laparotomies performed in Scotland during the period from 1st January 2001 - 31st December 2010. It will use routinely collected administrative data from the Information Services Division (ISD) of NHS National Services Scotland.
Emergency laparotomy will be defined as a non-elective abdominal procedure primarily on the gut tube; and such cases will be identified by the use of a set of procedural codes, which will be validated against local records.
Potentially significant confounding variables such as age, gender, and co-morbidity will be studied for their predictive value in a univariate model and included in a multivariate model if they remain significant. The primary outcome measure will be risk-adjusted 30 day/inpatient mortality, and secondary outcome measures will be 30 day readmission rate, 30 day re-operation rate, and post-operative length of stay.
研究设计
- 研究类型
- Observational
- 观察模型
- Ecologic Or Community
- 时间视角
- Retrospective
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •All patients aged 18 years or older who undergo emergency laparotomy within the study period
排除标准
- •Patients who are non-resident in Scotland
- •Multiple laparotomies on a single patient will not be counted as separate index events unless ≥6 months have passed between previous discharge and new hospital admission.
结局指标
主要结局
Mortality
时间窗: Either within 30 days of procedure, or during continuous in-patient stay
Death as an in-patient or ≤30 days of procedure. Deaths will be recognised from SMR01 which is linked to the Registrar General's database of deaths.
次要结局
- Re-admission(Within 30 days of index discharge)
- Re-operation(Within the index admission or within 30 days of discharge)
- Post-operative length of stay(From date of laparotomy to date of discharge (whole days) - see below)