The effect of ethnicity on in-hospital mortality following emergency abdominal surgery: a national cohort study using Hospital Episode Statistics

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The effect of ethnicity on in-hospital mortality following emergency abdominal surgery : a national cohort study using Hospital Episode Statistics. / Vohra, R S; Evison, F; Bejaj, I; Ray, D; Patel, P; Pinkney, T D.

In: Public Health, Vol. 129, No. 11, 11.2015, p. 1496-1502.

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@article{c95d67e38fd34afaa34c10e05845dead,
title = "The effect of ethnicity on in-hospital mortality following emergency abdominal surgery: a national cohort study using Hospital Episode Statistics",
abstract = "OBJECTIVES: Ethnicity has complex effects on health and the delivery of health care in part related to language and cultural barriers. This may be important in patients requiring emergency abdominal surgery where delays have profound impact on outcomes. The aim here was to test if variations in outcomes (e.g. in-hospital mortality) exist by ethnic group following emergency abdominal surgery.STUDY DESIGN: Retrospective cohort study using population-level routinely collected administrative data from England (Hospital Episode Statistics).METHODS: Adult patients undergoing emergency abdominal operations between April 2008 and March 2012 were identified. Operations were divided into: 'major', 'hepatobiliary' or 'appendectomy/minor'. The primary outcome was all cause in-hospital mortality. Univariable and multivariable analysis odds ratios (OR with 95% confidence intervals, CI) adjusting for selected factors were performed.RESULTS: 359,917 patients were identified and 80.7% of patients were White British, 4.7% White (Other), 2.4% Afro-Caribbean, 1.6% Indian, 2.6% Chinese, 3.1% Asian (Other) and 4.9% not known, with crude in-hospital mortality rates of 4.4%, 3.1%, 2.0%, 2.6%, 1.6%, 1.7% and 5.17%, respectively. The majority of patients underwent appendectomy/minor (61.9%) compared to major (20.9%) or hepatobiliary (17.2%) operations (P < 0.001) with an in-hospital mortality of 1.7%, 11.5% and 3.9% respectively. Adjusted mortality was largely similar across ethnic groups except where ethnicity was not recorded (compared to White British patients following major surgery OR 2.05, 95% 1.82-2.31, P < 0.01, hepatobiliary surgery OR 2.78, 95% CI 2.31-3.36, P = 0.01 and appendectomy/minor surgery OR 1.78, 95% 1.52-2.08, P < 0.01).CONCLUSIONS: Ethnicity is not associated with poorer outcomes following emergency abdominal surgery. However, ethnicity is not recorded in 5% of this cohort and this represents an important, yet un-definable, group with significantly poorer outcomes.",
keywords = "Abdomen, Adolescent, Adult, African Continental Ancestry Group, Aged, Asian Continental Ancestry Group, Continental Population Groups, Emergency Service, Hospital, England, Ethnic Groups, European Continental Ancestry Group, Female, Hospital Mortality, Humans, Male, Middle Aged, Retrospective Studies, Young Adult, Emergency surgery, Routinely collected data, Surgical outcomes",
author = "Vohra, {R S} and F Evison and I Bejaj and D Ray and P Patel and Pinkney, {T D}",
note = "Copyright {\textcopyright} 2015 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.",
year = "2015",
month = nov,
doi = "10.1016/j.puhe.2015.07.038",
language = "English",
volume = "129",
pages = "1496--1502",
journal = "Public Health",
issn = "0033-3506",
publisher = "WB Saunders",
number = "11",

}

RIS

TY - JOUR

T1 - The effect of ethnicity on in-hospital mortality following emergency abdominal surgery

T2 - a national cohort study using Hospital Episode Statistics

AU - Vohra, R S

AU - Evison, F

AU - Bejaj, I

AU - Ray, D

AU - Patel, P

AU - Pinkney, T D

N1 - Copyright © 2015 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

PY - 2015/11

Y1 - 2015/11

N2 - OBJECTIVES: Ethnicity has complex effects on health and the delivery of health care in part related to language and cultural barriers. This may be important in patients requiring emergency abdominal surgery where delays have profound impact on outcomes. The aim here was to test if variations in outcomes (e.g. in-hospital mortality) exist by ethnic group following emergency abdominal surgery.STUDY DESIGN: Retrospective cohort study using population-level routinely collected administrative data from England (Hospital Episode Statistics).METHODS: Adult patients undergoing emergency abdominal operations between April 2008 and March 2012 were identified. Operations were divided into: 'major', 'hepatobiliary' or 'appendectomy/minor'. The primary outcome was all cause in-hospital mortality. Univariable and multivariable analysis odds ratios (OR with 95% confidence intervals, CI) adjusting for selected factors were performed.RESULTS: 359,917 patients were identified and 80.7% of patients were White British, 4.7% White (Other), 2.4% Afro-Caribbean, 1.6% Indian, 2.6% Chinese, 3.1% Asian (Other) and 4.9% not known, with crude in-hospital mortality rates of 4.4%, 3.1%, 2.0%, 2.6%, 1.6%, 1.7% and 5.17%, respectively. The majority of patients underwent appendectomy/minor (61.9%) compared to major (20.9%) or hepatobiliary (17.2%) operations (P < 0.001) with an in-hospital mortality of 1.7%, 11.5% and 3.9% respectively. Adjusted mortality was largely similar across ethnic groups except where ethnicity was not recorded (compared to White British patients following major surgery OR 2.05, 95% 1.82-2.31, P < 0.01, hepatobiliary surgery OR 2.78, 95% CI 2.31-3.36, P = 0.01 and appendectomy/minor surgery OR 1.78, 95% 1.52-2.08, P < 0.01).CONCLUSIONS: Ethnicity is not associated with poorer outcomes following emergency abdominal surgery. However, ethnicity is not recorded in 5% of this cohort and this represents an important, yet un-definable, group with significantly poorer outcomes.

AB - OBJECTIVES: Ethnicity has complex effects on health and the delivery of health care in part related to language and cultural barriers. This may be important in patients requiring emergency abdominal surgery where delays have profound impact on outcomes. The aim here was to test if variations in outcomes (e.g. in-hospital mortality) exist by ethnic group following emergency abdominal surgery.STUDY DESIGN: Retrospective cohort study using population-level routinely collected administrative data from England (Hospital Episode Statistics).METHODS: Adult patients undergoing emergency abdominal operations between April 2008 and March 2012 were identified. Operations were divided into: 'major', 'hepatobiliary' or 'appendectomy/minor'. The primary outcome was all cause in-hospital mortality. Univariable and multivariable analysis odds ratios (OR with 95% confidence intervals, CI) adjusting for selected factors were performed.RESULTS: 359,917 patients were identified and 80.7% of patients were White British, 4.7% White (Other), 2.4% Afro-Caribbean, 1.6% Indian, 2.6% Chinese, 3.1% Asian (Other) and 4.9% not known, with crude in-hospital mortality rates of 4.4%, 3.1%, 2.0%, 2.6%, 1.6%, 1.7% and 5.17%, respectively. The majority of patients underwent appendectomy/minor (61.9%) compared to major (20.9%) or hepatobiliary (17.2%) operations (P < 0.001) with an in-hospital mortality of 1.7%, 11.5% and 3.9% respectively. Adjusted mortality was largely similar across ethnic groups except where ethnicity was not recorded (compared to White British patients following major surgery OR 2.05, 95% 1.82-2.31, P < 0.01, hepatobiliary surgery OR 2.78, 95% CI 2.31-3.36, P = 0.01 and appendectomy/minor surgery OR 1.78, 95% 1.52-2.08, P < 0.01).CONCLUSIONS: Ethnicity is not associated with poorer outcomes following emergency abdominal surgery. However, ethnicity is not recorded in 5% of this cohort and this represents an important, yet un-definable, group with significantly poorer outcomes.

KW - Abdomen

KW - Adolescent

KW - Adult

KW - African Continental Ancestry Group

KW - Aged

KW - Asian Continental Ancestry Group

KW - Continental Population Groups

KW - Emergency Service, Hospital

KW - England

KW - Ethnic Groups

KW - European Continental Ancestry Group

KW - Female

KW - Hospital Mortality

KW - Humans

KW - Male

KW - Middle Aged

KW - Retrospective Studies

KW - Young Adult

KW - Emergency surgery

KW - Routinely collected data

KW - Surgical outcomes

U2 - 10.1016/j.puhe.2015.07.038

DO - 10.1016/j.puhe.2015.07.038

M3 - Article

C2 - 26318618

VL - 129

SP - 1496

EP - 1502

JO - Public Health

JF - Public Health

SN - 0033-3506

IS - 11

ER -