Gulland, A. BMJ. 2016. 353:i2054
The move to centralised services for emergency general surgery would not improve outcomes or reduce mortality rates, a report has found.1
The Nuffield Trust looked at the problems facing emergency general surgery and found that the “widely held perception that centralisation will drive up quality” did not hold true. It found that there was no clear relationship between the number of procedures performed and surgical outcomes.
The report, commissioned by the Royal College of Surgeons of England, found that there was little variation in mortality between sites that performed a large number of procedures and those that did not. The report looked at hospital episode statistics at 154 sites in England between 2009-10 and 2012-13 to compare mortality rates between those that performed a large number of procedures and those that did not.
It found that hospitals that performed around 50 or fewer major emergency surgical procedures annually had a mortality rate of just over 12%. Sites that performed more than 250 procedures a year had a mortality rate of just under 12%, and sites that performed 51 to 100 procedures annually had the lowest mortality rate of about 11%.
When researchers looked at very low volume sites—those performing less than 20 procedures annually—they found that there was no clear pattern of higher mortality.
View the full report here
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