Cardiac rehabilitation versus standard care after aortic aneurysm repair (Aneurysm CaRe): study protocol for a randomised controlled trial.

Background: Abdominal and thoracic aortic aneurysms (A/TAA) are an important cause of mortality amongst the older population. Although A/TAA repair can be performed with low peri-operative risk, overall life expectancy remains poor in the years that follow surgery. The majority of deaths are caused by heart attack or stroke, which can both be prevented by cardiac rehabilitation (CR) in patients with clinically-manifest coronary artery disease.

Research activity and the association with mortality.

Introduction: The aims of this study were to describe the key features of acute NHS Trusts with different levels of research activity and to investigate associations between research activity and clinical outcomes.

Methods: National Institute for Health Research (NIHR) Comprehensive Clinical Research Network (CCRN) funding and number of patients recruited to NIHR Clinical Research Network (CRN) portfolio studies for each NHS Trusts were used as markers of research activity. Patient-level data for adult non-elective admissions were extracted from the English Hospital Episode Statistics (2005-10).

Variations and inter-relationship in outcome from emergency admissions in England: a retrospective analysis of Hospital Episode Statistics from 2005-2010.

Background: The quality of care delivered and clinical outcomes of care are of paramount importance. Wide variations in the outcome of emergency care have been suggested, but the scale of variation, and the way in which outcomes are inter-related are poorly defined and are critical to understand how best to improve services. This study quantifies the scale of variation in three outcomes for a contemporary cohort of patients undergoing emergency medical and surgical admissions.

Mortality from ruptured abdominal aortic aneurysms: clinical lessons from a comparison of outcomes in England and the USA.

Background: The outcome of patients with ruptured abdominal aortic aneurysm (rAAA) varies by country. Study of practice differences might allow the formulation of pathways to improve care.

Methods: We compared data from the Hospital Episode Statistics for England and the Nationwide Inpatient Sample for the USA for patients admitted to hospital with rAAA from 2005 to 2010.

Elective open suprarenal aneurysm repair in England from 2000 to 2010 an observational study of hospital episode statistics.

Background: Open surgery is widely used as a benchmark for the results of fenestrated endovascular repair of complex abdominal aortic aneurysms (AAA). However, the existing evidence stems from single-centre experiences, and may not be reproducible in wider practice. National outcomes provide valuable information regarding the safety of suprarenal aneurysm repair.

Epidemiological study of provision of cholecystectomy in England from 2000 to 2009: retrospective analysis of Hospital Episode Statistics.

Background: The aim of this study was to report the trends in provision of cholecystectomy in the National Health System in England over the 9 year period from 2000 to 2009 and to determine the major risk factors associated with subsequent poor outcome.

Methods: The Hospital Episode Statistics database was interrogated to identify all cholecystectomy procedures for biliary stone disease in adult patients (>16 years). Multivariate regression analyses were used to identify independent predictors of in-patient death, 1 year death, conversion to open, major bile duct injury (BDI) requiring operative repair, and length of stay.

Predictive value of peak systolic velocity for the development of graft limb complications after endovascular aneurysm repair.

Purpose: To determine the role of peak systolic velocity (PSV) data provided by duplex ultrasound (DUS) surveillance in the prediction of endograft limb complications after endovascular aneurysm repair (EVAR).

Methods: All 478 consecutive patients (425 men; mean age 75±7 years) who underwent infrarenal EVAR between 2004 and 2010 had DUS scans at 1.5, 3, 6, 9, 12, and 18 months and annually thereafter over a median follow-up of 43 months (range 1-92).

Studies using English administrative data (Hospital Episode Statistics) to assess health-care outcomes--systematic review and recommendations for reporting.

Background: Studies using English administrative data from the Hospital Episode Statistics (HES) are increasingly used for the assessment of health-care quality. This study aims to catalogue the published body of studies using HES data to assess health-care outcomes, to assess their methodological qualities and to determine if reporting recommendations can be formulated.

Methods: Systematic searches of the EMBASE, Medline and Cochrane databases were performed using defined search terms.

Effect of endovascular aneurysm repair on the volume-outcome relationship in aneurysm repair.

Background: We aim to quantify the relationship between the annual caseload (volume) and outcome from elective endovascular (EVR) or open repair of abdominal aortic aneurysms (AAAs) in England between 2005 and 2007.

Methods And Results: Individual patient data were obtained from the Hospital Episode Statistics. Statistical methods included multiple logistic regression models, mortality control charts, and safety plots to determine the nature of any relationship between volume and outcome.

The prevalence of neovascularity in patients clinically diagnosed with rotator cuff tendinopathy.

Background: Shoulder dysfunction is common and pathology of the rotator cuff tendons and subacromial bursa are considered to be a major cause of pain and morbidity. Although many hypotheses exist there is no definitive understanding as to the origin of the pain arising from these structures. Research investigations from other tendons have placed intra-tendinous neovascularity as a potential mechanism of pain production.

How to improve surgical outcomes.

Data should be monitored and acted on at local and national levels

Meta-analysis and systematic review of the relationship between surgeon annual caseload and mortality for elective open abdominal aortic aneurysm repairs.

Objective: To assess the relationship between the annual caseload of elective open abdominal aortic aneurysm (AAA) repairs performed by individual surgeons and mortality.

Methods: PubMed, EMBASE, and the Cochrane library were searched for articles on the volume-outcome relationship in AAA surgery. The review conformed to the QUOROM statement.

Surgical mortality score: risk management tool for auditing surgical performance.

Existing methods of risk adjustment in surgical audit are complex and costly. The present study aimed to develop a simple risk stratification score for mortality and a robust audit tool using the existing resources of the hospital Patient Administration System (PAS) database. This was an observational study for all patients undergoing surgical procedures over a two-year period, at a London university hospital.

Operative mortality in colorectal cancer: prospective national study.

Objective: To develop a mathematical model that will predict the probability of death after surgery for colorectal cancer.

Design: Descriptive study using routinely collected clinical data.

Data Source: The database of the Association of Coloproctology of Great Britain and Ireland (ACPGBI), encompassing 8077 patients with a new diagnosis of colorectal cancer in 73 hospitals during a 12 month period.

Mortality control charts for comparing performance of surgical units: validation study using hospital mortality data.

Objective: To design and validate a statistical method for evaluating the performance of surgical units that adjusts for case volume and case mix.

Design: Validation study using routinely collected data on in-hospital mortality.

Data Sources: Two UK databases, the ASCOT prospective database and the risk scoring collaborative (RISC) database, covering 1042 patients undergoing surgery in 29 hospitals for gastro-oesophageal cancer between 1995 and 2000.