Change in healthcare utilisation after surgical treatment: observational study of routinely collected patient data from primary and secondary care.
Br J Anaesth
; 129(6): 889-897, 2022 12.
Article
en En
| MEDLINE
| ID: mdl-36192218
ABSTRACT
BACKGROUND:
Most patients fully recover after surgery. However, high-risk patients may experience an increased burden of medical disease.METHODS:
We performed a prospectively planned analysis of linked routine primary and secondary care data describing adult patients undergoing non-obstetric surgery at four hospitals in East London between January 2012 and January 2017. We categorised patients by 90-day mortality risk using logistic regression modelling. We calculated healthcare contact days per patient year during the 2 yr before and after surgery, and express change using rate ratios (RaR) with 95% confidence intervals.RESULTS:
We included 70 021 patients, aged (mean [standard deviation, sd]) 49.8 (19) yr, with 1238 deaths within 2 yr after surgery (1.8%). Most procedures were elective (51 693, 74.0%), and 20 441 patients (29.1%) were in the most deprived national quintile for social deprivation. Elective patients had 12.7 healthcare contact days per patient year before surgery, increasing to 15.5 days in the 2 yr after surgery (RaR, 1.22 [1.21-1.22]), and those at high-risk of 90-day mortality (11% of population accounting for 80% of all deaths) had the largest increase (37.0 days per patient year before vs 60.8 days after surgery; RaR, 1.64 [1.63-1.65]). Emergency patients had greater increases in healthcare burden (13.8 days per patient year before vs 24.8 days after surgery; RaR, 1.8 [1.8-1.8]), particularly in high-risk patients (28% of patients accounting for 80% of all deaths by day 90), with 21.6 days per patient year before vs 49.2 days after surgery; RaR, 2.28 [2.26-2.29].DISCUSSION:
High-risk patients who survive the immediate perioperative period experience large and persistent increases in healthcare utilisation in the years after surgery. The full implications of this require further study.Palabras clave
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Atención Secundaria de Salud
/
Procedimientos Quirúrgicos Electivos
Tipo de estudio:
Observational_studies
Límite:
Adult
/
Humans
País/Región como asunto:
Europa
Idioma:
En
Revista:
Br J Anaesth
Año:
2022
Tipo del documento:
Article