scholarly journals SP3.2.12 Do the National Emergency Laparotomy Audit (NELA) performance indicators correlate with mortality? A retrospective analysis of years 4-6

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Lachlan Dick ◽  
Stefan Tucker ◽  
Fiona Bairstow ◽  
James Green ◽  
Jamie Young
Keyword(s):  
Critical Care ◽  
Performance Indicators ◽  
Performance Indicator ◽  
Average Rate ◽  
Multivariable Analysis ◽  
High Standard ◽  
The Elderly ◽  
Emergency Laparotomy ◽  
National Emergency ◽  
The Impact

Abstract Aims Emergency laparotomy continues to carry significant morbidity and mortality. The National Emergency Laparotomy Audit (NELA) publishes individual hospital reports, detailing key performance indicators. We aimed to determine the impact of performance indicators on mortality. Methods NELA aggregate hospital reports from years 4 to 6 were used to extract data relevant to the study aims. Linear regression was used to determine if any of the reported variables could be used as predictors of mortality. Results An analysis of 559 hospital aggregates, totalling 73075 laparotomies was carried out. Overall, the average rate of mortality was 9.6%. There was no significant correlation between mortality with any common variable across years 4-6 data, including risk documentation before surgery, arrival in theatre appropriate to urgency, consultant review preoperatively and supervision in theatre, admission to critical care, care of the elderly assessment, unplanned return to theatre or admission to critical care and length of stay. Conclusion No single performance indicator alone appears to correlate significantly with mortality. Multivariable analysis may identify some performance indicators, however, given that across all the hospitals there is a high standard of performance for each of the reported variables, the variation in mortality is likely influenced by other factors not evaluated by the hospital aggregate reports.

Abstract T P136: Potential Contributors to the Declining Impact of Stroke Risk Factors with Age: Implications for Stroke Epidemiology in the Elderly

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
George Howard ◽  
Mary Cushman ◽  
Maciej Banach ◽  
Brett M Kissela ◽  
David C Goff ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Stroke Risk ◽  
Multivariable Analysis ◽  
The Elderly ◽  
Stroke Risk Factors ◽  
Age Related ◽  
Increased Risk ◽  
The Impact ◽  
Age Related Changes

Purpose: The importance of stroke research in the elderly is increasing as America is “graying.” For most risk factors for most diseases (including stroke), the magnitude of association with incident events decreases at older ages. Potential changes in the impact of risk factors could be a “true” effect, or could be due to methodological issues such as age-related changes in residual confounding. Methods: REGARDS followed 27,748 stroke-free participants age 45 and over for an average of 5.3 years, during which 715 incident strokes occurred. The association of the “Framingham” risk factors (hypertension [HTN], diabetes, smoking, AFib, LVH and heart disease) with incident stroke risk was assessed in age strata of 45-64 (Young), 65-74 (Middle), and 75+ (Old). For those with and without an “index” risk factor (e.g., HTN), the average number of “other” risk factors was calculated. Results: With the exception of AFib, there was a monotonic decrease in the magnitude of the impact across the age strata, with HTN, diabetes, smoking and LVH even becoming non-significant in the elderly (Figure 1). However, for most factors, the increasing prevalence of other risk factors with age impacts primarily those with the index risk factor absent (Figure 2, example HTN as the “index” risk factor). Discussion: The impact of stroke risk factors substantially declined at older ages. However, this decrease is partially attributable to increases in the prevalence of other risk factors among those without the index risk factor, as there was little change in the prevalence of other risk factors in those with the index risk factor. Hence, the impact of the index risk factor is attenuated by increased risk in the comparison group. If this phenomenon is active with latent risk factors, estimates from multivariable analysis will also decrease with age. A deeper understanding of age-related changes in the impact of risk factors is needed.

scholarly journals 61 Impact of Dedicated Geriatrician Involvement on National Emergency Laparotomy Audit Standards and Outcomes

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii1-iii16
Author(s):  
Roisin Coary ◽  
Kath Jenkins ◽  
Emma Mitchell ◽  
Anne Pullyblank ◽  
David Shipway
Keyword(s):  
Older Patients ◽  
Ad Hoc ◽  
Gastrointestinal Surgery ◽  
Emergency Laparotomy ◽  
Published Data ◽  
Mortality And Morbidity ◽  
The United Kingdom ◽  
Service Introduction ◽  
National Emergency ◽  
The Impact

Abstract Background Older patients undergoing emergency laparotomy (EmLap) have high levels of mortality and morbidity. The National Emergency Laparotomy Audit (NELA) in the United Kingdom records processes and outcome measures for patients undergoing EmLap. Recent data shows that geriatrician review is associated with reduced post-surgical mortality (Oliver C.M. et al., British Journal of Anaesthesia 2018). Geriatrician review of all patients aged ≥70 years is a NELA standard. However, the most recent national report shows only 23% compliance, falling short of the target of 80% and consistently the poorest performing standard. Methods In August 2018, we established a dedicated gastrointestinal surgery liaison service to replace ad hoc geriatrician reviews. We evaluated the impact on NELA standard compliance and patient outcomes. Data were extracted from the local NELA database on all patients aged ≥70 years, for the first six months of the service (September to February). These were compared to the same time period in the preceding year prior to service launch. Results Following service introduction, increased numbers of patients aged ≥70 years underwent EmLap: 50 (2018-9) vs 31 (2017-8). Geriatrician review occurred in 86% (n=43) in 2018-9, compared to 16% (n=5) in 2017-8. Inpatient mortality fell from 23% (n=7) in 2017-8 to 14% (n=7) in 2018-9. Discharge to own home rose to 76% (n=38) in 2018-9 from 68% (n=21) in 2017-8. One patient in each cohort was newly discharged to a nursing home. Mean length of stay was 17.9 days in 2018-9 (range 3-75), versus 17.6 in 2017-8 (range 3-94). Conclusion Introduction of a dedicated geriatric surgical liaison service is associated with increased compliance with NELA standards. Despite more emergency laparotomies being performed on older patients, this was associated with improved mortality and rates of home discharge, consistent with published data. Targeted investment in surgical liaison services may therefore be warranted.

scholarly journals The impact of age on approach-related complications with navigated lateral lumbar interbody fusion

2020 ◽  
Vol 49 (3) ◽  
pp. E8
Author(s):  
Yamaan S. Saadeh ◽  
Clay M. Elswick ◽  
Eleanor Smith ◽  
Timothy J. Yee ◽  
Michael J. Strong ◽  
...  
Keyword(s):  
Risk Factor ◽  
Elderly Patients ◽  
Interbody Fusion ◽  
Multivariable Analysis ◽  
The Elderly ◽  
Lumbar Interbody Fusion ◽  
Related Complication ◽  
Lateral Lumbar Interbody Fusion ◽  
Increased Risk ◽  
The Impact

OBJECTIVEAge is known to be a risk factor for increased complications due to surgery. However, elderly patients can gain significant quality-of-life benefits from surgery. Lateral lumbar interbody fusion (LLIF) is a minimally invasive procedure that is commonly used to treat degenerative spine disease. Recently, 3D navigation has been applied to LLIF. The purpose of this study was to determine whether there is an increased complication risk in the elderly with navigated LLIF.METHODSPatients who underwent 3D-navigated LLIF for degenerative disease from 2014 to 2019 were included in the analysis. Patients were divided into elderly and nonelderly groups, with those 65 years and older categorized as elderly. Ninety-day medical and surgical complications were recorded. Patient and surgical characteristics were compared between groups, and multivariate regression analysis was used to determine independent risk factors for complication.RESULTSOf the 115 patients included, 56 were elderly and 59 were nonelderly. There were 15 complications (25.4%) in the nonelderly group and 10 (17.9%) in the elderly group, which was not significantly different (p = 0.44). On multivariable analysis, age was not a risk factor for complication (p = 0.52). However, multiple-level LLIF was associated with an increased risk of approach-related complication (OR 3.58, p = 0.02).CONCLUSIONSElderly patients do not appear to experience higher rates of approach-related complications compared with nonelderly patients undergoing 3D navigated LLIF. Rather, multilevel surgery is a predictor for approach-related complication.

scholarly journals Four Dissemination Pathways for a Social Media–Based Breastfeeding Campaign: Evaluation of the Impact on Key Performance Indicators (Preprint)

2019 ◽  
Author(s):  
Kassandra Harding ◽  
Rafael Pérez-Escamilla ◽  
Grace Carroll ◽  
Richmond Aryeetey ◽  
Opeyemi Lasisi
Keyword(s):  
Social Media ◽  
Performance Indicators ◽  
Performance Indicator ◽  
Low Cost ◽  
Social Media Marketing ◽  
Campaign Evaluation ◽  
Indicator Data ◽  
And Performance ◽  
Top 40 ◽  
The Impact

BACKGROUND Social media utilization is on the rise globally, and the potential of social media for health behavior campaigns is widely recognized. However, as the landscape of social media evolves, so do techniques used to optimize campaign dissemination. OBJECTIVE The primary aim of this study was to evaluate the impact of 4 material dissemination paths for a breastfeeding social media marketing campaign in Ghana on exposure and engagement with campaign material. METHODS Campaign materials (n=60) were posted to a Facebook and Twitter campaign page over 12 weeks (ie, baseline). The top 40 performing materials were randomized to 1 of 4 redissemination arms (control simply posted on each platform, key influencers, random influencers, and paid advertisements). Key performance indicator data (ie, exposure and engagement) were extracted from both Facebook and Twitter 2 days after the material was posted. A difference-in-difference model was used to examine the impact of the dissemination paths on performance. RESULTS At baseline, campaign materials received an average (SD) exposure of 1178 (670) on Facebook and 1071 (905) on Twitter (n=60). On Facebook, materials posted with paid advertisements had significantly higher exposure and engagement compared with the control arm (<italic>P</italic>&lt;.001), and performance of materials shared by either type of influencer did not differ significantly from the control arm. No differences in Twitter performance were detected across arms. CONCLUSIONS Paid advertisements are an effective mechanism to increase exposure and engagement of campaign posts on Facebook, which was achieved at a low cost.

scholarly journals EP.FRI.763 Impact of COVID-19 on the rates of emergency laparotomies at an acute general hospital in the United Kingdom

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Curtis Wright ◽  
Simon Kirkham ◽  
Alex Millward ◽  
Robert MacAdam
Keyword(s):  
Critical Care ◽  
United Kingdom ◽  
High Risk ◽  
Observational Study ◽  
Best Practice ◽  
Emergency Laparotomy ◽  
Single Centre ◽  
The United Kingdom ◽  
The Uk ◽  
National Emergency

Abstract Aims The aim of this study was to analyse if the COVID-19 pandemic had any effect on the number of emergency laparotomies performed each month at a single NHS Foundation Trust. Methods This single-centre retrospective observational study included all patients that underwent an emergency laparotomy that was registered as part of the National Emergency Laparotomy Audit (NELA) at Whiston Hospital in Merseyside, UK, between January 2019 and October 2020. The rates recorded throughout March and April 2020 (COVID) were then compared to the preceding 12 months until the first COVID death was recorded in the UK on March 5th, and the 6 months following the initial national lockdown. Results The number of emergency laparotomies performed each month declined from an average of 14.7 (95% CI 13.2 – 16.1) in the preceding 12 months to 5 during COVID (95% CI 5 – 5); a decrease of 65.9%. Following the easing of lockdown rules in early May, this decline was partly reversed with an average of 9.7 (95% CI 8.9 – 10.5) performed each month until October 2020, reflecting a 34.1% reduction from the pre-COVID baseline. The percentage of patients that achieved the NELA best practice tariffs also fell during COVID to 71% from an average of 79.3% (95% CI 76.0 – 82.7) due to fewer high risk laparotomies being admitted to Critical Care post-operatively. Conclusions During the COVID-19 pandemic, emergency laparotomy rates fell and have only partially recovered to pre-pandemic rates. Post-operative admission to critical care for high risk laparotomies also declined during this period. 

scholarly journals View. The Dutch Critical Care Triage Guideline on Covid-19: Not Necessarily Discriminatory

2020 ◽  
Vol 27 (5) ◽  
pp. 495-498
Author(s):  
André den Exter
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Selection Criterion ◽  
The Elderly ◽  
Medical Doctors ◽  
Age Limit ◽  
National Emergency

Abstract Recently, the Dutch Medical Doctors Association (Federatie Medisch Specialisten en de Koninklijke Nederlandsche Maatschappij tot bevordering der Geneeskunst) drafted the ‘Covid-19 triage guideline ICU admission’ that has age cut-offs that deprioritise or exclude the elderly. Such an age limit for intensive care unit (ICU) admission in case of a national emergency seems discriminatory, and thus, is it inappropriate to use, or not? The question is whether age in itself can be considered as an acceptable selection criterion.

scholarly journals Do Younger Patients with Muscle-Invasive Bladder Cancer have Better Outcomes?

2019 ◽  
Vol 8 (9) ◽  
pp. 1459 ◽  
Author(s):  
Florian Janisch ◽  
Hang Yu ◽  
Malte W. Vetterlein ◽  
Roland Dahlem ◽  
Oliver Engel ◽  
...  
Keyword(s):  
Cox Regression ◽  
Care Center ◽  
Tertiary Care ◽  
Tumor Biology ◽  
Survival Rates ◽  
Multivariable Analysis ◽  
Young Patients ◽  
The Elderly ◽  
Cancer Of The Bladder ◽  
The Impact

Urothelial cancer of the bladder (UCB) is usually a disease of the elderly. The influence of age on oncological outcomes remains controversial. This study aims to investigate the impact of age on UCB outcomes in Europe focusing particularly on young and very young patients. We collected data of 669 UCB patients treated with RC at our tertiary care center. We used various categorical stratifications as well as continuous age to investigate the association of age and tumor biology as well as endpoints with descriptive statistics and Cox regression. The median age was 67 years and the mean follow-up was 52 months. Eight patients (1.2%) were ≤40 years old and 39 patients (5.8%) were aged 41–50 years, respectively. In multivariable analysis, higher continuous age and age above the median were independent predictors for disease recurrence, and cancer-specific and overall mortality (all p-values ≤ 0.018). In addition, patients with age in the oldest tertile group had inferior cancer-specific and overall survival rates compared to their younger counterparts. Young (40–50 years) and very young (≤40 years) patients had reduced hazards for all endpoints, which, however, were not statistically significant. Age remains an independent determinant for survival after RC. Young adults did, however, not have superior outcomes in our analyses. Quality of life and complications are endpoints that need further evaluation in patients undergoing RC.

Analysis on the Impact of the Data Acquisition Board on the Performance Indicators of the Virtual Multi-Channel Pulse Height Analyzer

2014 ◽  
Vol 519-520 ◽  
pp. 1209-1213
Author(s):  
Feng Gao ◽  
Fang Fang Yang
Keyword(s):  
Data Acquisition ◽  
Performance Indicators ◽  
Performance Indicator ◽  
Mutual Influence ◽  
Sampling Rate ◽  
Pulse Height ◽  
Least Significant Bit ◽  
Pulse Height Analyzer ◽  
Data Acquisition Board ◽  
The Impact

The DAB (Data Acquisition Board) is a key component of the VMPHA (Virtual Multi-channel Pulse Height Analyzer). In order to assist the design of the VMPHA, the influence of the DAB on the performances of the VMPHA has been studied through the method of theoretical analysis in this paper. The Sampling Rate, the LSB (Least Significant Bit) and the Data Transfer Rate of the DAB have decisive effects on the performance of the VMPHA. The Sampling Rate and the LSB are the two main factors that determine the energy resolution which is one of the most important performance indicators for the VMPHA. Another most important performance indicator for the VMPHA, the number of channels, is determined by the LSB alone. Moreover, the relationship among the three key performance parameters of the DAB is mutual influence. At the end of the paper, the selection method of the DAB for developing a VMPHA is summarized and presented.

Sign in / Sign up

Export Citation Format

Share Document