Population-based information on emergency colorectal surgery and evaluation on effect of operative volume on mortality.

INTRODUCTION: Population-based information on emergency surgery for colorectal conditions was limited. The present study was designed to review comprehensively the outcomes of emergency colectomy in Hong Kong population and evaluate the effect of case load on mortality after considering case mixes. METHODS: All adult patients older than aged 18 years who underwent emergency colectomy in 2003 in all 15 Hong Kong public hospitals were included. Demographics and perioperative variables were reviewed and analyzed. Hospitals were classified into low, middle, or high operative volume groups according to their yearly caseloads, and their performance in terms of mortality were compared by using CR-POSSUM. RESULTS: A total of 864 patients with a mean age of 67.8 years were included. Bowel obstruction and peritonitis were the two major clinical indications for the surgery. The crude in-hospital mortality rate was 18.9%; individual hospitals varied from 8.7% to 33.3%. With the risk adjusted model, all hospital groups performed within 95% confidence limits of prediction. There was no statistical difference for mortality of hospitals of different case volume. CONCLUSION: A crude in-hospital mortality of 18.9% after emergency colorectal surgery was observed in Hong Kong public hospitals. Higher hospital case load is not significantly associated with better outcomes in emergency colectomy.

Evaluation of various POSSUM models for predicting mortality in patients undergoing elective oesophagectomy for carcinoma.

BACKGROUND: The aim of the study was to validate the use of the Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM), Portsmouth (P) POSSUM and upper gastrointestinal (O) POSSUM models in patients undergoing elective thoracic oesophagectomy for carcinoma. METHODS: The observed in-hospital mortality rates in 545 patients undergoing elective thoracic oesophagectomy for squamous cell carcinoma of the oesophagus in all public hospitals in Hong Kong was compared with rates predicted by POSSUM, P-POSSUM and O-POSSUM. The discriminatory power of these models was assessed using receiver-operator characteristic (ROC) curve analysis. RESULTS: The observed mortality rate was 5.5 per cent, whereas rates predicted by POSSUM, P-POSSUM and O-POSSUM were 15.0, 4.7 and 10.9 per cent respectively. P-POSSUM showed no lack of fit (P = 0.814), but POSSUM (P < 0.001) and O-POSSUM (P = 0.002) showed lack of fit against observed mortality. POSSUM overpredicted mortality across nearly all risk groups, whereas O-POSSUM overpredicted mortality in patients with low physiological scores and in older patients. POSSUM (area under ROC curve 0.776) and P-POSSUM (0.776) showed equally good discriminatory power but O-POSSUM (0.676) was inferior. CONCLUSION: P-POSSUM provided the most accurate prediction of in-hospital mortality in this group of patients who had elective oesophagectomy.

Medical informatics--the state of the art in the Hospital Authority.

Since its inception in 1990, the Hospital Authority (HA) has strongly supported the development and implementation of information systems both to improve the delivery of care and to make better information available to managers. This paper summarizes the progress to date and discusses current and future developments. Following the first two phases of the HA information technology strategy the basic infrastructural elements were laid in place. These included the foundation administrative and financial systems and databases; establishment of a wide area network linking all hospitals and clinics together; laboratory, radiology and pharmacy systems with access to results in the ward. A major push into clinical systems began in 1994 with the clinical management system (CMS), which established a clinical workstation for use in both ward and ambulatory settings. The CMS is now running at all major hospitals, and provides single logon access to almost all the electronically collected clinical data in the HA. The next phase of development is focussed on further support for clinical activities in the CMS. Key elements include the longitudinal electronic patient record (ePR), clinical order entry, generic support for clinical reports, broadening the scope to include allied health and the rehabilitative phase, clinical decision support, an improved clinical documentation framework, sharing of clinical information with other health care providers and a comprehensive data repository for analysis and reporting purposes.