ORCID Profile
0000-0002-4982-1374
Current Organisations
University College London Hospitals NHS Foundation Trust
,
University College London
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Publisher: Elsevier BV
Date: 04-2019
Publisher: Elsevier BV
Date: 10-2018
DOI: 10.1016/J.BJA.2018.07.002
Abstract: Cancellation of planned surgery impacts substantially on patients and health systems. This study describes the incidence and reasons for cancellation of inpatient surgery in the UK NHS. We conducted a prospective observational cohort study over 7 consecutive days in March 2017 in 245 NHS hospitals. Occurrences and reasons for previous surgical cancellations were recorded. Using multilevel logistic regression, we identified patient- and hospital-level factors associated with cancellation due to inadequate bed capacity. We analysed data from 14 936 patients undergoing planned surgery. A total of 1499 patients (10.0%) reported previous cancellation for the same procedure contemporaneous hospital census data indicated that 13.9% patients attending inpatient operations were cancelled on the day of surgery. Non-clinical reasons, predominantly inadequate bed capacity, accounted for a large proportion of previous cancellations. Independent risk factors for cancellation due to inadequate bed capacity included requirement for postoperative critical care [odds ratio (OR)=2.92 95% confidence interval (CI), 2.12-4.02 P<0.001] and the presence of an emergency department in the treating hospital (OR=4.18 95% CI, 2.22-7.89 P<0.001). Patients undergoing cancer surgery (OR=0.32 95% CI, 0.22-0.46 P<0.001), obstetric procedures (OR=0.17 95% CI, 0.08-0.32 P<0.001), and expedited surgery (OR=0.39 95% CI, 0.27-0.56 P<0.001) were less likely to be cancelled. A significant proportion of patients presenting for surgery have experienced a previous cancellation for the same procedure. Cancer surgery is relatively protected, but bed capacity, including postoperative critical care requirements, are significant risk factors for previous cancellations.
Publisher: National Institute for Health and Care Research
Date: 12-2022
DOI: 10.3310/EQAB4594
Abstract: A previous National Institute for Health and Care Research study [Harrison DA, Ferrando-Vivas P, Shahin J, Rowan KM. Ensuring comparisons of health-care providers are fair: development and validation of risk prediction models for critically ill patients. Health Serv Deliv Res 2015 3 (41)] identified the need for more research to understand risk factors and consequences of critical care and subsequent outcomes. First, to improve risk models for adult general critical care by developing models for mortality at fixed time points and time-to-event outcomes, end-stage renal disease, type 2 diabetes, health-care utilisation and costs. Second, to improve risk models for cardiothoracic critical care by enhancing risk factor data and developing models for longer-term mortality. Third, to improve risk models for in-hospital cardiac arrest by enhancing risk factor data and developing models for longer-term mortality and critical care utilisation. Risk modelling study linking existing data. NHS adult critical care units and acute hospitals in England. Patients admitted to an adult critical care unit or experiencing an in-hospital cardiac arrest. None. Mortality at hospital discharge, 30 days, 90 days and 1 year following critical care unit admission mortality at 1 year following discharge from acute hospital new diagnosis of end-stage renal disease or type 2 diabetes hospital resource use and costs return of spontaneous circulation sustained for 20 minutes survival to hospital discharge and 1 year and length of stay in critical care following in-hospital cardiac arrest. Case Mix Programme, National Cardiac Arrest Audit, UK Renal Registry, National Diabetes Audit, National Adult Cardiac Surgery Audit, Hospital Episode Statistics and Office for National Statistics. Data were linked for 965,576 critical care admissions between 1 April 2009 and 31 March 2016, and 83,939 in-hospital cardiac arrests between 1 April 2011 and 31 March 2016. For admissions to adult critical care units, models for 30-day mortality had similar predictors and performance to those for hospital mortality and did not reduce heterogeneity. Models for longer-term outcomes reflected increasing importance of chronic over acute predictors. New models for end-stage renal disease and diabetes will allow benchmarking of critical care units against these important outcomes and identification of patients requiring enhanced follow-up. The strongest predictors of health-care costs were prior hospitalisation, prior dependency and chronic conditions. Adding pre- and intra-operative risk factors to models for cardiothoracic critical care gave little improvement in performance. Adding comorbidities to models for in-hospital cardiac arrest provided modest improvements but were of greater importance for longer-term outcomes. Delays in obtaining linked data resulted in the data used being 5 years old at the point of publication: models will already require recalibration. Data linkage provided enhancements to the risk models underpinning national clinical audits in the form of additional predictors and novel outcomes measures. The new models developed in this report may assist in providing objective estimates of potential outcomes to patients and their families. (1) Develop and test care pathways for recovery following critical illness targeted at those with the greatest need (2) explore other relevant data sources for longer-term outcomes (3) widen data linkage for resource use and costs to primary care, outpatient and emergency department data. This study is registered as NCT02454257. This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research Vol. 10, No. 39. See the NIHR Journals Library website for further project information.
Publisher: Elsevier BV
Date: 04-2019
Publisher: Royal College of Physicians
Date: 07-2021
Publisher: Public Library of Science (PLoS)
Date: 15-10-2020
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Steve Harris.