Objectives: Emergency abdominal surgery (EAS) refers to high risk intra-abdominal surgical procedures associated
with increased mortality risk and long length of hospital stay. The variation between hospital volume and hospital length
of stay (LOS) of patients undergoing EAS is poorly understood. Our objective was to explore this relationship across
public hospitals in Ireland.
Methods: Data for all adult episode discharges from public Irish hospitals in 2014-2017 were obtained from National
Quality Assurance Improvement System (NQAIS) Clinical with EAS identified by primary procedure codes. Hospitals
were categorised into low (n<200), medium (n=200-400), and high (n>400) volume groups based on the number of EAS
episodes during the study period. Negative binomial regression models were applied to standardise for patient case mix.
Several adjusted LOS measures were compared across the three volume groups. Sensitivity analysis was conducted to
test the robustness of our findings.
Results: 8120 hospital episodes across 24 public hospitals providing EAS services were analysed. 7 were categorised
as low, 9 as medium, and 8 as high-volume hospitals. High volume hospitals had a significantly longer adjusted LOS
(24.7 days) relative to low and medium volume hospitals (18.2 and 18.6 days). Sensitivity analysis consisted of the
exclusion of the following hospital episodes: in-hospital death, cancer diagnosis, Charlson comorbidity index (CCI) >0,
admission from other hospitals, and discharge to other hospitals. No single variable influenced the observed LOS
variation, although when the more complex episodes were excluded, the post-operative LOS at low and medium volume
hospitals was significantly shorter compared to high volume hospitals (by 1.1-6.1 days). Intensive care unit (ICU) LOS
was similar in all three hospital volume groups although low volume hospitals appeared to have more ICU admissions
and longer stay (by up to 1.6 days).
Conclusions: Our findings indicate that patients treated at low volume hospitals have shorter LOS and may be
discharged earlier than from high volume hospitals. This finding is surprising, suggesting that concentration of services
to larger clinical departments may not necessarily reduce LOS and improve the efficiency of resource utilisation and
service delivery.
Impact of the COVID-19 pandemic on provision and outcomes of emergency abdominal surgery in Irish public hospitals
