Outcomes following emergency laparotomy in Australian public hospitals.

BACKGROUND: International studies reporting outcomes following emergency laparotomies have consistently demonstrated wide inter-hospital variation and a 30-day mortality in excess of 10%. The UK then prioritized the funding of the National Emergency Laparotomy Audit. In a prospective Western Australian audit there was minimal inter-hospital variation and a 6.6% 30-day mortality. In the absence of any multi-hospital Australian data the aim of the present study was to compare national administrative data with that previously reported. METHODS: Data on emergency laparotomies performed in Australian public hospitals during 2013/2014 and 2014/2015 were extracted from admitted patient activity and costing data sets collated by the Independent Hospital Pricing Authority. The data sets, containing episode-level data relating to admitted acute and sub-acute care patients, included administrative, demographic and clinical information such as patient age, cost, length of stay, in-hospital mortality, diagnosis and surgical procedure details. RESULTS: Ninety-nine public hospitals undertaking at least 50 emergency laparotomies performed 20 388 procedures over the 2 years. The overall in-hospital mortality was 5.2%. There was a wide interstate and inter-hospital variation in risk-adjusted in-hospital mortality (4.8-6.6% and 0-9.3%, respectively), length of stay (12.5-16.8 days and 5.8-18.9 days, respectively) and intensive care unit admissions (24.5-40.2% and 0-75.7%, respectively). CONCLUSION: This data suggest the wide variation in outcomes and care process observed overseas exist in Australia. However, administrative data has considerable limitations and is not a substitute for high quality prospective data. Minimizing variations through prospective quality improvement processes will improve patient outcomes.

Inpatient hospital use in the first year after release from prison: a Western Australian population-based record linkage study.

OBJECTIVE: To describe three aspects of inpatient use for ex-prisoners within the first 12 months of release from prison: the proportion of released prisoners who were hospitalised; the amount of resources used (bed days, separations and cost); and the most common reasons for hospitalisation. METHODS: Secondary analysis of whole-population linked prison and inpatient data from the Western Australian Data Linkage System. The main outcome measure was first inpatient admission within 12 months of release from prison between 2000 and 2002 and related resource use. RESULTS: One in five adults released from Western Australian prisons between 2000 and 2002 were hospitalised in the 12 months that followed, which translated into 12,074 inpatient bed days, 3,426 separations and costs of $10.4 million. Aboriginals, females and those released to freedom were most at risk of hospitalisation. Mental health disorders such as schizophrenia and depression, and injuries involving the head or face and/or fractures, accounted for 58.9% of all bed days. Ex-prisoners were 1.7 times more likely to be hospitalised during a year than Western Australia's general adult population of roughly the same age. CONCLUSIONS: Using whole-population administrative linked health and justice data, our findings show that prisoners are vulnerable to hospitalisation in the 12-month period following their release from prison, particularly Aboriginals, females and those with known mental health problems. IMPLICATIONS: Further research is needed to assess whether contemporary services to support community re-entry following incarceration have led to a measurable reduction in hospital contacts, especially for the subgroups identified in this study.

Use of gastrostomy tubes in older Western Australians: a population-based study of frequency, indications and outcomes.

OBJECTIVE: To determine the number of older Western Australians who had a gastrostomy tube (GT) placement from 1994 to 2004, to describe their characteristics, and to examine outcomes after GT placement, including rehospitalisation for complications and survival. DESIGN AND DATA SOURCES: Secondary analysis of hospital (inpatient) data and linked mortality data from the WA Data Linkage System. MAIN OUTCOME MEASURES: Patient characteristics (age, sex and morbidity profile); numbers of GT closures, replacements and complications within 1 year of GT placement; age- and sex-specific survival outcomes calculated at 7, 30, 60 and 180 days, and 1 and 3 years; and mortality hazard ratios calculated for six conditions of interest, identified using all available diagnosis information on the inpatient record. RESULTS: In Western Australia, 2023 people aged 65 years or older underwent a GT placement for the first time during the period 1994-2004, half of whom had a known history of cerebrovascular disease (50.3%). Rehospitalisation within 1 year for a GT replacement procedure, mechanical complications and incident pneumonitis occurred in 13%, 4% and 9% of patients, respectively. More than half of the patients who underwent a GT placement died within 1 year. Survival outcomes were poorest for patients with motor neurone disease and metastatic cancer. CONCLUSION: To better understand this complex area of health care, questions regarding decision making -- by patients, families, physicians, hospitals and other caring organisations -- about GT placement and maintenance need to be addressed.