hospital episode statistics
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2022 ◽  
pp. 152660282110709
Author(s):  
Antonios Vitalis ◽  
Alena Shantsila ◽  
Mark Kay ◽  
Rajiv K. Vohra ◽  
Gregory Y. H. Lip

Purpose Various studies, mainly from North America, report worse outcomes in ethnic minority populations submitted to revascularization for peripheral arterial disease (PAD). Limited nationwide data in relation to ethnicity are available from Europe. Objective The objective of the study is to compare the outcomes of femoral angioplasty/stenting procedures among different ethnic groups in England during the 10-year period from 2006 to 2015. Materials and Methods The “Hospital Episode Statistics” database has been searched using International Classification of Diseases, Tenth Revision ( ICD-10) codes to identify all cases of femoral angioplasty or stenting from English NHS Hospitals between January 1, 2006, and December 31, 2015. Subsequent mortality, second open or endovascular infrainguinal procedures, and major amputations on the same side within 2 years after the first procedure have been recorded. Patients were broadly categorized according to ethnicity as whites, Asians, and blacks. Chi-square test was used to demonstrate significant differences among ethnic groups and odds ratios (ORs) were calculated using white ethnic group as reference. Results A total number of 70 887 femoral endovascular procedures were recorded in patients from the 3 ethnic groups. Two-year mortality in whites, Asians, and blacks was 18.3%, 22.1%, and 19.5% (p<0.001); rates of second endovascular procedure were 12.1%, 13.1%, and 13.5% (p=0.24); rates of open infrainguinal procedure were 5.6%, 4.5%, and 8.0% (p<0.001); and rates of major amputation were 4.8%, 4.1%, and 7.0% (p<0.001), respectively. Mortality was higher in Asians (OR=1.26, 95% confidence interval [CI]=1.10-1.45, p<0.01) compared with whites. On the contrary, blacks underwent more open arterial operations (OR=1.48, 95% CI=1.19-1.83, p<0.01) and more amputations (OR=1.49, 95% CI=1.18-1.87, p<0.01). There were no significant differences in the rates of second endovascular procedures. Conclusion Two-year mortality after femoral angioplasty/stenting is higher in Asians, whereas risk of limb loss is higher in blacks compared with whites. Reasons of these ethnic differences in outcomes following femoral endovascular procedures for PAD merit further study.


PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0261850
Author(s):  
Hasan Raza Mohammad ◽  
Rachael Gooberman-Hill ◽  
Antonella Delmestri ◽  
John Broomfield ◽  
Rita Patel ◽  
...  

Objective Identify risk factors for poor pain outcomes six months after primary knee replacement surgery. Methods Observational cohort study on patients receiving primary knee replacement from the UK Clinical Practice Research Datalink, Hospital Episode Statistics and Patient Reported Outcomes. A wide range of variables routinely collected in primary and secondary care were identified as potential predictors of worsening or only minor improvement in pain, based on the Oxford Knee Score pain subscale. Results are presented as relative risk ratios and adjusted risk differences (ARD) by fitting a generalized linear model with a binomial error structure and log link function. Results Information was available for 4,750 patients from 2009 to 2016, with a mean age of 69, of whom 56.1% were female. 10.4% of patients had poor pain outcomes. The strongest effects were seen for pre-operative factors: mild knee pain symptoms at the time of surgery (ARD 18.2% (95% Confidence Interval 13.6, 22.8), smoking 12.0% (95% CI:7.3, 16.6), living in the most deprived areas 5.6% (95% CI:2.3, 9.0) and obesity class II 6.3% (95% CI:3.0, 9.7). Important risk factors with more moderate effects included a history of previous knee arthroscopy surgery 4.6% (95% CI:2.5, 6.6), and use of opioids 3.4% (95% CI:1.4, 5.3) within three months after surgery. Those patients with worsening pain state change had more complications by 3 months (11.8% among those in a worse pain state vs. 2.7% with the same pain state). Conclusions We quantified the relative importance of individual risk factors including mild pre-operative pain, smoking, deprivation, obesity and opioid use in terms of the absolute proportions of patients achieving poor pain outcomes. These findings will support development of interventions to reduce the numbers of patients who have poor pain outcomes.


Author(s):  
Nicolás Libuy ◽  
Katie Harron ◽  
Ruth Gilbert ◽  
Richard Caulton ◽  
Ellen Cameron ◽  
...  

IntroductionLinkage of administrative data for universal state education and National Health Service (NHS) hospital care would enable research into the inter-relationships between education and health for all children in England. ObjectivesWe aim to describe the linkage process and evaluate the uality of linkage of four one-year birth cohorts within the National Pupil Database (NPD) and Hospital Episode Statistics (HES). MethodsWe used multi-step deterministic linkage algorithms to link longitudinal records from state schools to the chronology of records in the NHS Personal Demographics Service (PDS; linkage stage 1), and HES (linkage stage 2). We calculated linkage rates and compared pupil characteristics in linked and unlinked samples for each stage of linkage and each cohort (1990/91, 1996/97, 1999/00, and 2004/05). ResultsOf the 2,287,671 pupil records, 2,174,601 (95%) linked to HES. Linkage rates improved over time (92% in 1990/91 to 99% in 2004/05). Ethnic minority pupils and those living in more deprived areas were less likely to be matched to hospital records, but differences in pupil characteristics between linked and unlinked samples were moderate to small. ConclusionWe linked nearly all pupils to at least one hospital record. The high coverage of the linkage represents a unique opportunity for wide-scale analyses across the domains of health and education. However, missed links disproportionately affected ethnic minorities or those living in the poorest neighbourhoods: selection bias could be mitigated by increasing the quality and completeness of identifiers recorded in administrative data or the application of statistical methods that account for missed links. Highlights • Longitudinal administrative records for all children attending state school and acute hospital services in England have been used for research for more than two decades, but lack of a shared unique identifier has limited scope for linkage between these databases. • We applied multi-step deterministic linkage algorithms to 4 one-year cohorts of children born 1 September-31 August in 1990/91, 1996/97, 1999/00 and 2004/05. In stage 1, full names, date of birth, and postcode histories from education data in the National Pupil Database were linked to the NHS Personal Demographic Service. In stage 2, NHS number, postcode, date of birth and sex were linked to hospital records in Hospital Episode Statistics. • Between 92% and 99% of school pupils linked to at least one hospital record. Ethnic minority pupils and pupils who were living in the most deprived areas were least likely to link. Ethnic minority pupils were less likely than white children to link at the first step in both algorithms. • Bias due to linkage errors could lead to an underestimate of the health needs in disadvantaged groups. Improved data quality, more sensitive linkage algorithms, and/or statistical methods that account for missed links in analyses, should be considered to reduce linkage bias.


2021 ◽  
Vol 6 ◽  
pp. 182
Author(s):  
Jonny Alejandro Garcia Luna ◽  
Eduardo López-Medina ◽  
Norman Danilo Maldonado-Vargas ◽  
Adrian D. Smith

Randomized clinical trials are the cornerstone design for the evaluation of the safety and efficacy of health interventions. Furthermore, morbidity and mortality rates could be reduced if evidence of better interventions is sought and used to inform medical practice. However, only small to moderate, yet worthwhile, effects can be expected from such interventions. Therefore, moderate random error and moderate biases must be avoided during the design, conduct and analysis of trials. Routinely collected data, such as vital statistics, hospital episode statistics and surveillance data, could be used to enhance recruitment and follow-up a large number of patients, reducing both random error and moderate biases. Here, we discuss the opportunities and challenges for the use of these data for clinical studies in Colombia.


2021 ◽  
Vol 17 (Sup3) ◽  
pp. S28-S31
Author(s):  
Gale Metcalfe ◽  
Audrey Owen

Background: It has been identified that nearly one-in-five people with multiple sclerosis (MS) have been admitted to hospital as a non-elective admission in 2018–2019. The average national stay is 7.7 days, at an average cost of £2844. Emergency hospital admissions for people with multiple sclerosis are rising nationally. Method: The authors conducted a 12-month audit of non-elective admissions across two clinical sites, comparing and contrasting the data gathered with national Hospital Episode Statistics. The outcome of the data collection influenced changes in local service delivery. Findings: The most common reasons identified for non-elective admissions related to MS were associated with respiratory issues (4255 admissions), with the most common single cause being urinary tract infections (2960 admissions). Bladder and bowel issues combined also accounted for 3550 admissions in 2018/19. Conclusion: The data identified urinary tract infections and sepsis as the largest presentation of non-elective MS admissions to both trusts. Certain recommendations have been made that will contribute to the improvement of service delivery and better quality care.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Balinskaite Violeta ◽  
Bottle Alex ◽  
Aylin Paul

Abstract Background To assess the impact on seven-day in-hospital mortality following the introduction in 2012 of a shadowing programme for new UK medical graduates requiring them to observe the doctor they are replacing for at least 4 days before starting work. Methods Data on emergency admissions were derived from Hospital Episode Statistics between 2003 and 2019. A generalised estimating equation model was used to examine whether the introduction of the programme was associated with a change in mortality. Results There were 644,018 emergency admissions, of which 1.8% (7612) ended in death in hospital within a week following the admission. Throughout the study period, there was an annual increase in the number of emergency admissions during July and August, though in-hospital mortality rates declined. The generalised estimating equation analysis found no significant change in the odds of death within 7 days after admission for patients admitted on the first Wednesday in August compared with patients admitted on the last Wednesday in July (OR = 1.03, 95% CI 0.94–1.13, p = 0.53). Furthermore, there was no significant change observed for any clinical diagnosis category following the introduction of the shadowing programme. Conclusion There was a rising trend in the number of emergency admissions over the study period, though mortality was decreasing. We found no significant association between the introduction of shadowing programme and in-hospital mortality; however, lack of power means that we cannot rule out a small effect on mortality. There are other outcomes that might have changed but were not examined in this study.


2021 ◽  
Vol 79 ◽  
pp. S420
Author(s):  
R. Veeratterapillay ◽  
P Gravestock ◽  
A. Rogers ◽  
C. Harding ◽  
K. Keltie ◽  
...  

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