Outcomes for surgical procedures funded by the English health service but carried out in public versus independent hospitals: a database study.
patient safety
quality measurement
surgery
Journal
BMJ quality & safety
ISSN: 2044-5423
Titre abrégé: BMJ Qual Saf
Pays: England
ID NLM: 101546984
Informations de publication
Date de publication:
07 2022
07 2022
Historique:
received:
13
04
2021
accepted:
08
07
2021
pubmed:
9
9
2021
medline:
23
6
2022
entrez:
8
9
2021
Statut:
ppublish
Résumé
The outcomes of elective surgery in public versus Independent Sector Healthcare Providers (ISHPs) are a matter of policy relevance and theoretical interest. Retrospective study of all National Health Service (NHS) hospitals and ISHPs in England that provided NHS-funded elective surgery. We used data from the England-wide Hospital Episode Statistics to study 18 common surgical procedures performed between 2006 and 2019. In-hospital outcomes included length of stay, emergency transfers to another hospital or death. Posthospital outcomes included readmission or death within 28 days. Outcomes were compared for each operation type by propensity score matching and survival analysis. The data set included 3 203 331 operations in 734 NHS hospitals and 468 259 operations in 274 ISHPs.In-hospital outcomes: Across all 18 included operation types, length of stay was significantly longer for patients treated in NHS hospitals compared with ISHPs. Effect sizes ranged from a hazard ratio (HR) of 2.15 (95% CI 1.72 to 2.68) for total hip replacement to 1.07 (95% CI 1.05 to 1.09) for wisdom tooth removal; a mean difference of 2.49 and 0.02 days, respectively.Postdischarge outcomes: Treatment at an ISHP was associated with a lower risk of emergency readmission compared with NHS treatment. HRs ranged from 0.36 (95% CI 0.28 to 0.46) for lumbar decompression to 0.75 (95% CI 0.67 to 0.85) for cholecystectomy; absolute risk differences of 1.5 and 1.3 percentage points. There was no difference in mortality. Elective surgery in an ISHP is associated with shorter lengths of stay and lower readmission rates than treatment in NHS hospitals across 18 operation types. The data were matched on observable covariates, but we cannot exclude selection bias due to unobserved confounders.
Sections du résumé
BACKGROUND
The outcomes of elective surgery in public versus Independent Sector Healthcare Providers (ISHPs) are a matter of policy relevance and theoretical interest.
METHODS
Retrospective study of all National Health Service (NHS) hospitals and ISHPs in England that provided NHS-funded elective surgery. We used data from the England-wide Hospital Episode Statistics to study 18 common surgical procedures performed between 2006 and 2019. In-hospital outcomes included length of stay, emergency transfers to another hospital or death. Posthospital outcomes included readmission or death within 28 days. Outcomes were compared for each operation type by propensity score matching and survival analysis.
RESULTS
The data set included 3 203 331 operations in 734 NHS hospitals and 468 259 operations in 274 ISHPs.In-hospital outcomes: Across all 18 included operation types, length of stay was significantly longer for patients treated in NHS hospitals compared with ISHPs. Effect sizes ranged from a hazard ratio (HR) of 2.15 (95% CI 1.72 to 2.68) for total hip replacement to 1.07 (95% CI 1.05 to 1.09) for wisdom tooth removal; a mean difference of 2.49 and 0.02 days, respectively.Postdischarge outcomes: Treatment at an ISHP was associated with a lower risk of emergency readmission compared with NHS treatment. HRs ranged from 0.36 (95% CI 0.28 to 0.46) for lumbar decompression to 0.75 (95% CI 0.67 to 0.85) for cholecystectomy; absolute risk differences of 1.5 and 1.3 percentage points. There was no difference in mortality.
CONCLUSION
Elective surgery in an ISHP is associated with shorter lengths of stay and lower readmission rates than treatment in NHS hospitals across 18 operation types. The data were matched on observable covariates, but we cannot exclude selection bias due to unobserved confounders.
Identifiants
pubmed: 34493605
pii: bmjqs-2021-013522
doi: 10.1136/bmjqs-2021-013522
pmc: PMC9234423
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Pagination
515-525Subventions
Organisme : Department of Health
Pays : United Kingdom
Commentaires et corrections
Type : CommentIn
Informations de copyright
© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.
Références
BMC Health Serv Res. 2008 Apr 09;8:78
pubmed: 18400096
BMJ. 2007 Oct 20;335(7624):806-8
pubmed: 17947786
BMJ. 2011 Oct 19;343:d6404
pubmed: 22012180
J R Soc Med. 2010 Aug 1;103(8):322-31
pubmed: 20610618
Med Care. 2005 Nov;43(11):1130-9
pubmed: 16224307
Health Econ. 2013 Feb;22(2):234-42
pubmed: 22223593
Sociol Methodol. 2012 Aug;42(1):314-347
pubmed: 23482633
BMC Health Serv Res. 2018 Nov 16;18(1):863
pubmed: 30445942
J Public Health (Oxf). 2012 Mar;34(1):138-48
pubmed: 21795302
Int J Epidemiol. 2017 Aug 1;46(4):1093-1093i
pubmed: 28338941
BMJ. 2020 Feb 19;368:m362
pubmed: 32075796