Frequency of surgical treatment and related hospital procedures in the United Kingdom: A national ecological study using hospital episode statistics
British Journal Of Anaesthesia
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Background. Despite evidence of high activity, the number of surgical procedures performed in United Kingdom hospitals, their cost, and subsequent mortality remain unclear. Methods. Time-trend ecological study using hospital episode data from England, Scotland, Wales and Northern Ireland. The primary outcome was the number of in-hospital procedures, grouped using three increasingly specific categories of surgery. Secondary outcomes were all-cause mortality, length of hospital stay and healthcare costs according to standard NHS tariffs. Results. Between 1st April 2009 and 31st March 2014, 39,631,801 surgical patient episodes were recorded. There was an annual average of 7,926,360 procedures (inclusive category), 5,104,165 procedures (intermediate category) and 1,526,421 procedures (restrictive category). This equates to 12,537, 8,073 and 2,414 procedures per 100,000 population per year respectively. On average there were 85,181 deaths (1.1%) within 30 days of a procedure each year, rising to 178,040 deaths (2.3%) after 90 days. Approximately 62.8% of all procedures were day-cases. Median length of stay for in-patient procedures was 1.7 (1.3- 2.0) days. The total cost of surgery over the five-year period was £54.6 billion ($104.4 billion), representing an average annual cost of £10.9 billion (inclusive), £9.5 billion (intermediate) and £5.6 billion (restrictive). For each category, the number of procedures increased each year, while mortality decreased. One third of all mortalities in national death registers occurred within 90 days of a procedure (inclusive category). Conclusions. The number of surgical procedures in the UK varies widely according to definition. The number of procedures is slowly increasing whilst the number of deaths is decreasing.
AuthorsAbbott, T; Pearse, R; Dobbs, TD; Harrison, EM; Gillies, MA; Fowler, AJ
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