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Conference paperTilney HS, Heriot AG, Purkayastha S, et al., 2008,
A national perspective on the decline of abdominoperineal resection for rectal cancer
, Pages: 77-84, ISSN: 0003-4932OBJECTIVE: To assess rates of abdominoperineal excision of the rectum (APER) for rectal cancer between centers and over time, and to evaluate the influence of patient characteristics, including social deprivation, on APER rate. METHODS: Data on patients undergoing APER or anterior resection (AR) in England were extracted from a national administrative database for the years 1996 to 2004. The primary outcome was the proportion of patients presenting with rectal cancer undergoing APER. Hierarchical logistic regression was used to identify independent factors associated with a nonrestorative resection. RESULTS: Data on 52,643 patients were analyzed, 13,109(24.9%) of whom underwent APER. The APER rate significantly reduced over the study period from 29.4% to 21.2% (P < 0.001). Operative mortality following AR decreased significantly during the period of study (5.1% to 4.2%, P = 0.002), while that following APER did not (P = 0.075). Male patients were more likely to undergo APER (P < 0.001), whereas those with an emergency presentation more commonly underwent AR (P < 0.001). Independent predictors of increased APER rate were male gender (odds ratio [OR] = 1.239, P < 0.001) and social deprivation (most vs. least deprived; OR = 1.589, P < 0.001), whereas increasing patient age (OR = 0.977, P = 0.027 per 10-year increase), year of study (2003/4 vs. 1996/7; OR = 0.646, P < 0.001) and initial presentation as an emergency (OR = 0.713, P < 0.001) were associated with lower APER rates. After accounting for case-mix, there was significant between-center variability in APER rates. CONCLUSION: Socially deprived patients were more likely to undergo abdominoperineal resection. Significant improvements in rates of nonrestorative resection were seen over time but although short-term outcomes following AR have improved, those following APER have not. Permanent stoma rates following rectal cancer surgery may be considered a surrogate marker of surgical quality. ©
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Journal articleTilney HS, Heriot AG, Purkayastha S, et al., 2008,
A national perspective on the decline of abdominoperineal resection for rectal cancer
, ANNALS OF SURGERY, Vol: 247, Pages: 77-84, ISSN: 0003-4932- Author Web Link
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- Citations: 111
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Journal articleFaiz O, Aylin P, Bottle A, 2008,
Changing trends in surgery for acute appendicitis (Br J Surg 2008; 95: 363-368)
, The British journal of surgery, Vol: 95, ISSN: 1365-2168 -
Journal articleFaiz O, Blackburn SC, Clark J, et al., 2008,
Laparoscopic and conventional appendicectomy in children: outcomes in English hospitals between 1996 and 2006
, Pediatric surgery international, Vol: 24, Pages: 1223-1227, ISSN: 0179-0358BACKGROUND: Laparoscopic appendicectomy is increasingly used in children. This national retrospective study compared outcomes of paediatric open and laparoscopic appendicectomy. METHODS: Length of stay, readmission rates and mortality in children undergoing open and laparoscopic appendicectomy in English NHS Trusts between 1 April 1996 and 31 March 2006 were compared. Procedures coded as emergency excision of appendix (OPCS-4 H01) on the Hospital Episode Statistics (HES) database in patients less than 15 years of age were included. Multivariate analysis was used to identify independent predictors of length of hospital stay and mortality. RESULTS: Eighty-nine thousand, four-hundred and ninety-seven (89,497) appendicectomies were studied; of which, 2,689 (3%) were performed laparoscopically. The percentage of laparoscopic cases rose from 0.6 to 8.4% between 1996 and 2006 (Pearson's r = 0.954, P < 0.001). Length of stay (median 3, interquartile range 2 days, P = 0.068) and 28-day readmission rates were similar (6.3 vs. 7.2%, respectively; P = 0.072) between groups. No independent hospital stay advantage for laparoscopy was observed (P = 0.121). No difference in 30-day mortality (P = 0.986) or 365-day mortality (P = 0.598) was demonstrated. CONCLUSION: Hospital stay, readmission rates and mortality are similar following laparoscopic and open appendicectomy in children.
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Journal articleFaiz O, Clark J, Brown T, et al., 2008,
Traditional and laparoscopic appendectomy in adults: outcomes in English NHS hospitals between 1996 and 2006
, Annals of surgery, Vol: 248, Pages: 800-806OBJECTIVE: This study investigated length of stay, readmission rates, and postoperative mortality in adult patients undergoing traditional and laparoscopic appendectomy in England between April 1, 1996, and March 31, 2006. METHODS: All procedures coded to the "H01-Emergency Excision of Appendix" procedure code in the Hospital Episode Statistics database were included. Multivariate analyses were used to identify independent predictors of length of hospital stay, 30-day and 365-day mortality. RESULTS: A total of 259,735 procedures were assigned to the H01-Emergency excision of appendix OPCS-4 3-digit code procedure between 1996 and 2006. A laparoscopic technique was employed in 16,315 (6.3%). A greater proportion of deaths occurred in hospital within 30 days of "open" appendectomy surgery (0.25%) compared with procedures utilizing a laparoscopic technique (0.09%, P < 0.001). One-year mortality rates, measured over a 5-year period, were also higher after open surgery (0.64% vs. 0.29%, P < 0.001). Multiple logistic regressions demonstrated that an open operative technique, older age, male gender, and increasing comorbidity were strong independent determinants of early and 1-year postoperative mortality after emergency appendectomy. The duration of stay for patients undergoing open emergency appendectomy exceeded that for patients undergoing the laparoscopic technique (P < 0.001). Patients undergoing a laparoscopic technique were, however, more likely to be readmitted within 28 days of surgery (7.10% vs. 4.95%, P < 0.001). CONCLUSIONS: Laparoscopic appendectomy is safe and associated with lower postoperative mortality rates than open procedures. The cost implications are uncertain as this technique is associated with shorter hospital stay but higher subsequent readmission rates.
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Journal articleAylin P, Bottle A, Faiz O, 2008,
Demonstrating safety through in-hospital mortality analysis following elective abdominal aortic aneurysm repair in England (Br J Surg 2008; 95: 64-71)
, The British journal of surgery, Vol: 95, ISSN: 1365-2168 -
Journal articleAylin P, Bottle A, 2007,
Are hospital league tables calculated correctly? A commentary
, PUBLIC HEALTH, Vol: 121, Pages: 905-906, ISSN: 0033-3506- Author Web Link
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- Citations: 3
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Journal articleAylin P, Bottle A, Elliott P, 2007,
Surgical mortality -: Hospital episode statistics <i>v</i> central cardiac audit database
, BRITISH MEDICAL JOURNAL, Vol: 335, Pages: 839-839, ISSN: 0959-8146- Author Web Link
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- Citations: 13
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Journal articleAylin P, Bottle A, Majeed A, 2007,
Use of administrative data or clinical databases as predictors of risk of death in hospital: comparison of models
, BMJ-BRITISH MEDICAL JOURNAL, Vol: 334, Pages: 1044-1047, ISSN: 0959-535X- Author Web Link
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- Citations: 221
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Journal articleAylin P, Lees T, Baker S, et al., 2007,
Descriptive study comparing routine hospital administrative data with the vascular society of Great Britain and Ireland's National Vascular Database
, EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY, Vol: 33, Pages: 461-465, ISSN: 1078-5884- Author Web Link
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- Citations: 67
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