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2.
ANZ J Surg ; 88(10): 998-1002, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30159997

RESUMO

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.


Assuntos
Assistência à Saúde/economia , Emergências/economia , Laparotomia/mortalidade , Austrália/epidemiologia , Assistência à Saúde/normas , Grupos Diagnósticos Relacionados/economia , Grupos Diagnósticos Relacionados/estatística & dados numéricos , Emergências/enfermagem , Feminino , Mortalidade Hospitalar/etnologia , Mortalidade Hospitalar/tendências , Hospitais Públicos , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Masculino , /estatística & dados numéricos , Estudos Prospectivos
4.
ANZ J Surg ; 87(11): 893-897, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28836320

RESUMO

BACKGROUND: Emergency laparotomies (ELs) are associated with high mortality and substantial outcome variation. There is no prospective Australian data on ELs. The aim of this study was to audit outcome after ELs in Western Australia. METHODS: A 12-week prospective audit was completed in 10 hospitals. Data collected included patient demographics, the clinical pathway, preoperative risk assessment and outcomes including 30-day mortality and length of stay. RESULTS: Data were recorded for 198 (76.2%) of 260 patients. The 30-day mortality was 6.5% (17/260) in participating hospitals, and 5.4% (19 of 354) across Western Australia. There was minimal variation between the three tertiary hospitals undertaking 220 of 354 (62.1%) ELs. The median and mean post-operative lengths of stay, excluding patients who died, were 8 and 10 days, respectively. In the 48 patients with a prospectively documented risk of ≥10%, both a consultant surgeon and anaesthetist were present for 68.8%, 62.8% were admitted to critical care and 45.8% commenced surgery within 2 h. The mortality in those retrospectively (62; 31%) and prospectively risk-assessed was 9.5% and 5.2%, respectively. CONCLUSION: This prospective EL audit demonstrated low 30-day mortality with little inter-hospital variation. Individual hospitals have scope to improve their standards of care. The importance of prospective risk assessment is clear.


Assuntos
Serviços Médicos de Emergência/métodos , Laparotomia/efeitos adversos , Auditoria Médica/legislação & jurisprudência , Medição de Risco/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Laparotomia/mortalidade , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Estudos Prospectivos , Padrão de Cuidado/ética , Austrália Ocidental/epidemiologia
6.
BJU Int ; 115(3): 466-72, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25265457

RESUMO

OBJECTIVE: To evaluate the effects of bariatric surgery on lower urinary tract symptoms (LUTS) in a prospective cohort study. PATIENTS AND METHODS: Patients undergoing bariatric surgery were recruited into the study. LUTS were assessed using the International Prostate Symptoms Score (IPSS) in men and Bristol Female Lower Urinary Tract Symptoms Score Questionnaire (BFLUTS) in women. Serum glucose, insulin and prostate-specific antigen (PSA) levels were recorded; insulin resistance was quantified using the Homeostasis Model Assessment (HOMA-IR) method. Patients were assessed before surgery, and at 6-8 weeks and 1 year after surgery. Weight loss, change in body mass index (BMI), total symptoms score as well as individual symptoms were tested for statistical significance with correction for multiple testing using Bonferroni method. Linear regression analysis was performed with total symptoms score change at 1 year as the outcome variable and BMI, age, total symptoms score before surgery, HOMA-IR, glucose level before surgery, insulin level before surgery, change in insulin level after surgery, weight loss and BMI loss as predictor variables. RESULTS: In all, 86 patients were recruited and 82% completed at least one follow-up after surgery. There was significant weight loss and reduction of BMI after surgery (P < 0.001). At 6 weeks, there was a significant reduction in overall symptom score (P < 0.001) and this improvement was sustained at 1 year. Linear regression analysis showed that total symptoms score at baseline, HOMA-IR, preoperative insulin level and change in insulin level postoperatively were predictive of the change in total symptoms score while the amount of weight loss was not. CONCLUSIONS: The study confirms the improvement in LUTS after weight loss but there is no correlation between the improvement and the time course or degree of weight loss. Rather there is a suggestion that the improvement in symptoms is linked to improvement in insulin resistance seen as a result of both bariatric surgery and weight loss.


Assuntos
Cirurgia Bariátrica , Sintomas do Trato Urinário Inferior/fisiopatologia , Adulto , Glicemia/metabolismo , Índice de Massa Corporal , Feminino , Humanos , Insulina/sangue , Sintomas do Trato Urinário Inferior/sangue , Sintomas do Trato Urinário Inferior/metabolismo , Sintomas do Trato Urinário Inferior/cirurgia , Masculino , Síndrome Metabólica/sangue , Síndrome Metabólica/metabolismo , Pessoa de Meia-Idade , Estudos Prospectivos , Análise de Regressão , Resultado do Tratamento , Perda de Peso
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