Multicentre observational study of performance variation in provision and outcome of emergency appendicectomy

A. Bhangu; C. Richardson; A. Torrance; T. Pinkney; C. Battersby; D. Beral; J. Cornish; H. Dent; N. Hall; T. Palser; I. Panagiotopoulou; S. Strong; R. Velineni; N. Chatzizacharias; M. Rana; K. Rollins; F. Ejtehadi; B. Jha; Y. Tan; N. Fanous; G. Markides; A. Tan; C. Marshal; S. Akhtar; D. Mullassery; A. Ismail; C. Hitchins; S. Sharif; L. Osborne; N. Sengupta; C. Challand; D. Pournaras; K. Bevan; J. King; J. Massey; I. Sandhu; J. Wells; D. Teichmann; A. Peckham-Cooper; M. Sellers; S. Folaranmi; B. Davies; S. Potter; D. Egbeare; C. Kallaway; S. Parsons; E. Upchurch; A. Lazaridis; D. Cocker; D. King; N. Behar; S. Loukogeorgakis; R. Kalaiselvan; S. Marzouk; E. Turner; S. Kaptanis; V. Kaur; G. Shingler; A. Bennett; S. Shaikh; M. Aly; J. Coad; T. Khong; Z. Nouman; J. Crawford; P. Szatmary; H. West; A. MacDonald; J. Lambert; K. Gash; K. Hanks; E. Griggs; L. Humphreys; J. Hardman; L. Taylor; D. Rex; J. Bennett; N. Crowther; B. McAree; S. Flexer; P. Mistry; P. Jain; M. Hwang; N. Oswald; A. Wells; H. Newsome; P. Martinez; C. Alvarez; J. Lein; D. Carradice; R. Gohil; M. Mount; A. Campbell; S. Iype; E. Dyson; T. Groot-Wassink; A. Ross; C. Jones; P. Charlesworth; N. Baylem; J. Voll; T. Sian; L. Creedon; G. Hicks; J. Goring; V. Ng; S. Tiboni; B. Rees; P. Ravindra; C. Neophytou; T. Lo; L. Broom; M. O'Connell; R. Foulkes; D. Griffith; K. Butcher; O. Mclaren; A. Tai; H. Yano; H. Torrance; O. Moussa; D. Mittapalli; D. Watt; S. Basson; J. Gilliland; S. Pilgrim; A. Wilkins; J. Yee; H. Cain; M. Wilson; J. Pearson; E. Turnbull; A. Brigic; N. Yassin; J. Clarke; S. Mallappa; P. Jackson; B. Lakshminarayanan; A. Sharma; K. Fareed; G. Yip; A. Brown; N. Patel; M. Ghisel; N. Tanner; H. Jones; J. Witherspoon; M. Phillips; M. Ho; S. Ng; T. Mak; N. Campain; D. Mukhey; W. Mitchell; F. Amawi; E. Dickson; S. Aggarwal; L. Satherley; F. Asprou; C. Keys; M. Steven; M. Johnstone; J. Muhlschlegel; E. Hamilton; J. Yin; M. Dilworth; A. Wright; P. Spreadborough; M. Singh; K. Mockford; J. Morgan; W. Ball; J. Royle; J. Lacy-Colson; W. Lai; S. Griffiths; S. Mitchell; C. Parsons; A. Joel; P. Mason; G. Harrison; J. Steinke; H. Rafique; W. Hawkins; D. Gurram; C. Hateley; A. Penkethman; C. Lambden; A. Conway; P. Dent; D. Yacob; O. Oshin; A. Hargreaves; G. Gossedge; J. Long; M. Walls; K. Futaba; S. Puig; A. Boddy; A. Jones; C. Tennuci; N. Battersby; R. Wilkin; C. Lloyd; E. Sein; K. McEvoy; L. Whisker; A. Colori; P. Sinclair; M. Loughran; A. Lawrence; J. Horsnell; J. Bagenal; A. Pisesky; S. Mastoridis; K. Solanki; I. Siddiq; L. Merker; P. Sarmah; D. Hanratty; L. Evans; M. Mortimer; A. Bhalla; D. Bartlett; N. Blencowe; J. Haddow

doi:10.1002/bjs.9201

Multicentre observational study of performance variation in provision and outcome of emergency appendicectomy

A. Bhangu^*, C. Richardson, A. Torrance, T. Pinkney, C. Battersby, D. Beral, J. Cornish, H. Dent, N. Hall, T. Palser, I. Panagiotopoulou, S. Strong, R. Velineni, N. Chatzizacharias, M. Rana, K. Rollins, F. Ejtehadi, B. Jha, Y. Tan, N. FanousG. Markides, A. Tan, C. Marshal, S. Akhtar, D. Mullassery, A. Ismail, C. Hitchins, S. Sharif, L. Osborne, N. Sengupta, C. Challand, D. Pournaras, K. Bevan, J. King, J. Massey, I. Sandhu, J. Wells, D. Teichmann, A. Peckham-Cooper, M. Sellers, S. Folaranmi, B. Davies, S. Potter, D. Egbeare, C. Kallaway, S. Parsons, E. Upchurch, A. Lazaridis, D. Cocker, D. King, N. Behar, S. Loukogeorgakis, R. Kalaiselvan, S. Marzouk, E. Turner, S. Kaptanis, V. Kaur, G. Shingler, A. Bennett, S. Shaikh, M. Aly, J. Coad, T. Khong, Z. Nouman, J. Crawford, P. Szatmary, H. West, A. MacDonald, J. Lambert, K. Gash, K. Hanks, E. Griggs, L. Humphreys, J. Hardman, L. Taylor, D. Rex, J. Bennett, N. Crowther, B. McAree, S. Flexer, P. Mistry, P. Jain, M. Hwang, N. Oswald, A. Wells, H. Newsome, P. Martinez, C. Alvarez, J. Lein, D. Carradice, R. Gohil, M. Mount, A. Campbell, S. Iype, E. Dyson, T. Groot-Wassink, A. Ross, C. Jones, P. Charlesworth, N. Baylem, J. Voll, T. Sian, L. Creedon, G. Hicks, J. Goring, V. Ng, S. Tiboni, B. Rees, P. Ravindra, C. Neophytou, T. Lo, L. Broom, M. O'Connell, R. Foulkes, D. Griffith, K. Butcher, O. Mclaren, A. Tai, H. Yano, H. Torrance, O. Moussa, D. Mittapalli, D. Watt, S. Basson, J. Gilliland, S. Pilgrim, A. Wilkins, J. Yee, H. Cain, M. Wilson, J. Pearson, E. Turnbull, A. Brigic, N. Yassin, J. Clarke, S. Mallappa, P. Jackson, B. Lakshminarayanan, A. Sharma, K. Fareed, G. Yip, A. Brown, N. Patel, M. Ghisel, N. Tanner, H. Jones, J. Witherspoon, M. Phillips, M. Ho, S. Ng, T. Mak, N. Campain, D. Mukhey, W. Mitchell, F. Amawi, E. Dickson, S. Aggarwal, L. Satherley, F. Asprou, C. Keys, M. Steven, M. Johnstone, J. Muhlschlegel, E. Hamilton, J. Yin, M. Dilworth, A. Wright, P. Spreadborough, M. Singh, K. Mockford, J. Morgan, W. Ball, J. Royle, J. Lacy-Colson, W. Lai, S. Griffiths, S. Mitchell, C. Parsons, A. Joel, P. Mason, G. Harrison, J. Steinke, H. Rafique, W. Hawkins, D. Gurram, C. Hateley, A. Penkethman, C. Lambden, A. Conway, P. Dent, D. Yacob, O. Oshin, A. Hargreaves, G. Gossedge, J. Long, M. Walls, K. Futaba, S. Puig, A. Boddy, A. Jones, C. Tennuci, N. Battersby, R. Wilkin, C. Lloyd, E. Sein, K. McEvoy, L. Whisker, A. Colori, P. Sinclair, M. Loughran, A. Lawrence, J. Horsnell, J. Bagenal, A. Pisesky, S. Mastoridis, K. Solanki, I. Siddiq, L. Merker, P. Sarmah, D. Hanratty, L. Evans, M. Mortimer, A. Bhalla, D. Bartlett, N. Blencowe, J. Haddow

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

166 Scopus citations

Abstract

Background Identification of variation in practice is a key step towards standardization of service and determination of reliable quality markers. This study aimed to investigate variation in provision and outcome of emergency appendicectomy. Methods A multicentre, trainee-led, protocol-driven, prospective observational cohort study was performed during May and June 2012. The main outcome of interest was the normal histopathology rate; secondary outcomes were laparoscopy and 30-day adverse event rates. Analysis included funnel plots and binary logistic regression models to identify patient- and hospital-related predictors of outcome. Results A total of 3326 patients from 95 centres were included. An initial laparoscopic approach was performed in 66·3 per cent of patients (range in centres performing more than 25 appendicectomies over the study period: 8·7-100 per cent). A histologically normal appendix was removed in 20·6 per cent of patients (range in centres performing more than 25 procedures: 3·3-36·8 per cent). Funnel plot analysis revealed that 22 centres fell below three standard deviations of the mean for laparoscopy rates. Higher centre volume, consultant presence in theatre and daytime surgery were independently associated with an increased use of laparoscopy, which in turn was associated with a reduction in 30-day morbidity (adjusted for disease severity). Daytime surgery further reduced normal appendicectomy rates. Increasing volume came at the cost of higher negative rates, and low negative rates came at the cost of higher perforation rates. Conclusion This study reveals the extremely wide variation in practice patterns and outcomes among hospitals. Organizational factors leading to this variation have been identified and should be addressed to improve performance. Appendicitis care in disgrace

Original language	English
Pages (from-to)	1240-1252
Number of pages	13
Journal	British Journal of Surgery
Volume	100
Issue number	9
DOIs	https://doi.org/10.1002/bjs.9201
State	Published - 1 Aug 2013
Externally published	Yes

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10.1002/bjs.9201

Cite this

Bhangu, A., Richardson, C., Torrance, A., Pinkney, T., Battersby, C., Beral, D., Cornish, J., Dent, H., Hall, N., Palser, T., Panagiotopoulou, I., Strong, S., Velineni, R., Chatzizacharias, N., Rana, M., Rollins, K., Ejtehadi, F., Jha, B., Tan, Y., ... Haddow, J. (2013). Multicentre observational study of performance variation in provision and outcome of emergency appendicectomy. British Journal of Surgery, 100(9), 1240-1252. https://doi.org/10.1002/bjs.9201

@article{80f89bde0cc24510a395a231c513c63e,

title = "Multicentre observational study of performance variation in provision and outcome of emergency appendicectomy",

abstract = "Background Identification of variation in practice is a key step towards standardization of service and determination of reliable quality markers. This study aimed to investigate variation in provision and outcome of emergency appendicectomy. Methods A multicentre, trainee-led, protocol-driven, prospective observational cohort study was performed during May and June 2012. The main outcome of interest was the normal histopathology rate; secondary outcomes were laparoscopy and 30-day adverse event rates. Analysis included funnel plots and binary logistic regression models to identify patient- and hospital-related predictors of outcome. Results A total of 3326 patients from 95 centres were included. An initial laparoscopic approach was performed in 66·3 per cent of patients (range in centres performing more than 25 appendicectomies over the study period: 8·7-100 per cent). A histologically normal appendix was removed in 20·6 per cent of patients (range in centres performing more than 25 procedures: 3·3-36·8 per cent). Funnel plot analysis revealed that 22 centres fell below three standard deviations of the mean for laparoscopy rates. Higher centre volume, consultant presence in theatre and daytime surgery were independently associated with an increased use of laparoscopy, which in turn was associated with a reduction in 30-day morbidity (adjusted for disease severity). Daytime surgery further reduced normal appendicectomy rates. Increasing volume came at the cost of higher negative rates, and low negative rates came at the cost of higher perforation rates. Conclusion This study reveals the extremely wide variation in practice patterns and outcomes among hospitals. Organizational factors leading to this variation have been identified and should be addressed to improve performance. Appendicitis care in disgrace",

author = "A. Bhangu and C. Richardson and A. Torrance and T. Pinkney and C. Battersby and D. Beral and J. Cornish and H. Dent and N. Hall and T. Palser and I. Panagiotopoulou and S. Strong and R. Velineni and N. Chatzizacharias and M. Rana and K. Rollins and F. Ejtehadi and B. Jha and Y. Tan and N. Fanous and G. Markides and A. Tan and C. Marshal and S. Akhtar and D. Mullassery and A. Ismail and C. Hitchins and S. Sharif and L. Osborne and N. Sengupta and C. Challand and D. Pournaras and K. Bevan and J. King and J. Massey and I. Sandhu and J. Wells and D. Teichmann and A. Peckham-Cooper and M. Sellers and S. Folaranmi and B. Davies and S. Potter and D. Egbeare and C. Kallaway and S. Parsons and E. Upchurch and A. Lazaridis and D. Cocker and D. King and N. Behar and S. Loukogeorgakis and R. Kalaiselvan and S. Marzouk and E. Turner and S. Kaptanis and V. Kaur and G. Shingler and A. Bennett and S. Shaikh and M. Aly and J. Coad and T. Khong and Z. Nouman and J. Crawford and P. Szatmary and H. West and A. MacDonald and J. Lambert and K. Gash and K. Hanks and E. Griggs and L. Humphreys and J. Hardman and L. Taylor and D. Rex and J. Bennett and N. Crowther and B. McAree and S. Flexer and P. Mistry and P. Jain and M. Hwang and N. Oswald and A. Wells and H. Newsome and P. Martinez and C. Alvarez and J. Lein and D. Carradice and R. Gohil and M. Mount and A. Campbell and S. Iype and E. Dyson and T. Groot-Wassink and A. Ross and C. Jones and P. Charlesworth and N. Baylem and J. Voll and T. Sian and L. Creedon and G. Hicks and J. Goring and V. Ng and S. Tiboni and B. Rees and P. Ravindra and C. Neophytou and T. Lo and L. Broom and M. O'Connell and R. Foulkes and D. Griffith and K. Butcher and O. Mclaren and A. Tai and H. Yano and H. Torrance and O. Moussa and D. Mittapalli and D. Watt and S. Basson and J. Gilliland and S. Pilgrim and A. Wilkins and J. Yee and H. Cain and M. Wilson and J. Pearson and E. Turnbull and A. Brigic and N. Yassin and J. Clarke and S. Mallappa and P. Jackson and B. Lakshminarayanan and A. Sharma and K. Fareed and G. Yip and A. Brown and N. Patel and M. Ghisel and N. Tanner and H. Jones and J. Witherspoon and M. Phillips and M. Ho and S. Ng and T. Mak and N. Campain and D. Mukhey and W. Mitchell and F. Amawi and E. Dickson and S. Aggarwal and L. Satherley and F. Asprou and C. Keys and M. Steven and M. Johnstone and J. Muhlschlegel and E. Hamilton and J. Yin and M. Dilworth and A. Wright and P. Spreadborough and M. Singh and K. Mockford and J. Morgan and W. Ball and J. Royle and J. Lacy-Colson and W. Lai and S. Griffiths and S. Mitchell and C. Parsons and A. Joel and P. Mason and G. Harrison and J. Steinke and H. Rafique and W. Hawkins and D. Gurram and C. Hateley and A. Penkethman and C. Lambden and A. Conway and P. Dent and D. Yacob and O. Oshin and A. Hargreaves and G. Gossedge and J. Long and M. Walls and K. Futaba and S. Puig and A. Boddy and A. Jones and C. Tennuci and N. Battersby and R. Wilkin and C. Lloyd and E. Sein and K. McEvoy and L. Whisker and A. Colori and P. Sinclair and M. Loughran and A. Lawrence and J. Horsnell and J. Bagenal and A. Pisesky and S. Mastoridis and K. Solanki and I. Siddiq and L. Merker and P. Sarmah and D. Hanratty and L. Evans and M. Mortimer and A. Bhalla and D. Bartlett and N. Blencowe and J. Haddow",

year = "2013",

month = aug,

day = "1",

doi = "10.1002/bjs.9201",

language = "English",

volume = "100",

pages = "1240--1252",

journal = "British Journal of Surgery",

issn = "0007-1323",

number = "9",

}

Bhangu, A, Richardson, C, Torrance, A, Pinkney, T, Battersby, C, Beral, D, Cornish, J, Dent, H, Hall, N, Palser, T, Panagiotopoulou, I, Strong, S, Velineni, R, Chatzizacharias, N, Rana, M, Rollins, K, Ejtehadi, F, Jha, B, Tan, Y, Fanous, N, Markides, G, Tan, A, Marshal, C, Akhtar, S, Mullassery, D, Ismail, A, Hitchins, C, Sharif, S, Osborne, L, Sengupta, N, Challand, C, Pournaras, D, Bevan, K, King, J, Massey, J, Sandhu, I, Wells, J, Teichmann, D, Peckham-Cooper, A, Sellers, M, Folaranmi, S, Davies, B, Potter, S, Egbeare, D, Kallaway, C, Parsons, S, Upchurch, E, Lazaridis, A, Cocker, D, King, D, Behar, N, Loukogeorgakis, S, Kalaiselvan, R, Marzouk, S, Turner, E, Kaptanis, S, Kaur, V, Shingler, G, Bennett, A, Shaikh, S, Aly, M, Coad, J, Khong, T, Nouman, Z, Crawford, J, Szatmary, P, West, H, MacDonald, A, Lambert, J, Gash, K, Hanks, K, Griggs, E, Humphreys, L, Hardman, J, Taylor, L, Rex, D, Bennett, J, Crowther, N, McAree, B, Flexer, S, Mistry, P, Jain, P, Hwang, M, Oswald, N, Wells, A, Newsome, H, Martinez, P, Alvarez, C, Lein, J, Carradice, D, Gohil, R, Mount, M, Campbell, A, Iype, S, Dyson, E, Groot-Wassink, T, Ross, A, Jones, C, Charlesworth, P, Baylem, N, Voll, J, Sian, T, Creedon, L, Hicks, G, Goring, J, Ng, V, Tiboni, S, Rees, B, Ravindra, P, Neophytou, C, Lo, T, Broom, L, O'Connell, M, Foulkes, R, Griffith, D, Butcher, K, Mclaren, O, Tai, A, Yano, H, Torrance, H, Moussa, O, Mittapalli, D, Watt, D, Basson, S, Gilliland, J, Pilgrim, S, Wilkins, A, Yee, J, Cain, H, Wilson, M, Pearson, J, Turnbull, E, Brigic, A, Yassin, N, Clarke, J, Mallappa, S, Jackson, P, Lakshminarayanan, B, Sharma, A, Fareed, K, Yip, G, Brown, A, Patel, N, Ghisel, M, Tanner, N, Jones, H, Witherspoon, J, Phillips, M, Ho, M, Ng, S, Mak, T, Campain, N, Mukhey, D, Mitchell, W, Amawi, F, Dickson, E, Aggarwal, S, Satherley, L, Asprou, F, Keys, C, Steven, M, Johnstone, M, Muhlschlegel, J, Hamilton, E, Yin, J, Dilworth, M, Wright, A, Spreadborough, P, Singh, M, Mockford, K, Morgan, J, Ball, W, Royle, J, Lacy-Colson, J, Lai, W, Griffiths, S, Mitchell, S, Parsons, C, Joel, A, Mason, P, Harrison, G, Steinke, J, Rafique, H, Hawkins, W, Gurram, D, Hateley, C, Penkethman, A, Lambden, C, Conway, A, Dent, P, Yacob, D, Oshin, O, Hargreaves, A, Gossedge, G, Long, J, Walls, M, Futaba, K, Puig, S, Boddy, A, Jones, A, Tennuci, C, Battersby, N, Wilkin, R, Lloyd, C, Sein, E, McEvoy, K, Whisker, L, Colori, A, Sinclair, P, Loughran, M, Lawrence, A, Horsnell, J, Bagenal, J, Pisesky, A, Mastoridis, S, Solanki, K, Siddiq, I, Merker, L, Sarmah, P, Hanratty, D, Evans, L, Mortimer, M, Bhalla, A, Bartlett, D, Blencowe, N & Haddow, J 2013, 'Multicentre observational study of performance variation in provision and outcome of emergency appendicectomy', British Journal of Surgery, vol. 100, no. 9, pp. 1240-1252. https://doi.org/10.1002/bjs.9201

TY - JOUR

T1 - Multicentre observational study of performance variation in provision and outcome of emergency appendicectomy

AU - Bhangu, A.

AU - Richardson, C.

AU - Torrance, A.

AU - Pinkney, T.

AU - Battersby, C.

AU - Beral, D.

AU - Cornish, J.

AU - Dent, H.

AU - Hall, N.

AU - Palser, T.

AU - Panagiotopoulou, I.

AU - Strong, S.

AU - Velineni, R.

AU - Chatzizacharias, N.

AU - Rana, M.

AU - Rollins, K.

AU - Ejtehadi, F.

AU - Jha, B.

AU - Tan, Y.

AU - Fanous, N.

AU - Markides, G.

AU - Tan, A.

AU - Marshal, C.

AU - Akhtar, S.

AU - Mullassery, D.

AU - Ismail, A.

AU - Hitchins, C.

AU - Sharif, S.

AU - Osborne, L.

AU - Sengupta, N.

AU - Challand, C.

AU - Pournaras, D.

AU - Bevan, K.

AU - King, J.

AU - Massey, J.

AU - Sandhu, I.

AU - Wells, J.

AU - Teichmann, D.

AU - Peckham-Cooper, A.

AU - Sellers, M.

AU - Folaranmi, S.

AU - Davies, B.

AU - Potter, S.

AU - Egbeare, D.

AU - Kallaway, C.

AU - Parsons, S.

AU - Upchurch, E.

AU - Lazaridis, A.

AU - Cocker, D.

AU - King, D.

AU - Behar, N.

AU - Loukogeorgakis, S.

AU - Kalaiselvan, R.

AU - Marzouk, S.

AU - Turner, E.

AU - Kaptanis, S.

AU - Kaur, V.

AU - Shingler, G.

AU - Bennett, A.

AU - Shaikh, S.

AU - Aly, M.

AU - Coad, J.

AU - Khong, T.

AU - Nouman, Z.

AU - Crawford, J.

AU - Szatmary, P.

AU - West, H.

AU - MacDonald, A.

AU - Lambert, J.

AU - Gash, K.

AU - Hanks, K.

AU - Griggs, E.

AU - Humphreys, L.

AU - Hardman, J.

AU - Taylor, L.

AU - Rex, D.

AU - Bennett, J.

AU - Crowther, N.

AU - McAree, B.

AU - Flexer, S.

AU - Mistry, P.

AU - Jain, P.

AU - Hwang, M.

AU - Oswald, N.

AU - Wells, A.

AU - Newsome, H.

AU - Martinez, P.

AU - Alvarez, C.

AU - Lein, J.

AU - Carradice, D.

AU - Gohil, R.

AU - Mount, M.

AU - Campbell, A.

AU - Iype, S.

AU - Dyson, E.

AU - Groot-Wassink, T.

AU - Ross, A.

AU - Jones, C.

AU - Charlesworth, P.

AU - Baylem, N.

AU - Voll, J.

AU - Sian, T.

AU - Creedon, L.

AU - Hicks, G.

AU - Goring, J.

AU - Ng, V.

AU - Tiboni, S.

AU - Rees, B.

AU - Ravindra, P.

AU - Neophytou, C.

AU - Lo, T.

AU - Broom, L.

AU - O'Connell, M.

AU - Foulkes, R.

AU - Griffith, D.

AU - Butcher, K.

AU - Mclaren, O.

AU - Tai, A.

AU - Yano, H.

AU - Torrance, H.

AU - Moussa, O.

AU - Mittapalli, D.

AU - Watt, D.

AU - Basson, S.

AU - Gilliland, J.

AU - Pilgrim, S.

AU - Wilkins, A.

AU - Yee, J.

AU - Cain, H.

AU - Wilson, M.

AU - Pearson, J.

AU - Turnbull, E.

AU - Brigic, A.

AU - Yassin, N.

AU - Clarke, J.

AU - Mallappa, S.

AU - Jackson, P.

AU - Lakshminarayanan, B.

AU - Sharma, A.

AU - Fareed, K.

AU - Yip, G.

AU - Brown, A.

AU - Patel, N.

AU - Ghisel, M.

AU - Tanner, N.

AU - Jones, H.

AU - Witherspoon, J.

AU - Phillips, M.

AU - Ho, M.

AU - Ng, S.

AU - Mak, T.

AU - Campain, N.

AU - Mukhey, D.

AU - Mitchell, W.

AU - Amawi, F.

AU - Dickson, E.

AU - Aggarwal, S.

AU - Satherley, L.

AU - Asprou, F.

AU - Keys, C.

AU - Steven, M.

AU - Johnstone, M.

AU - Muhlschlegel, J.

AU - Hamilton, E.

AU - Yin, J.

AU - Dilworth, M.

AU - Wright, A.

AU - Spreadborough, P.

AU - Singh, M.

AU - Mockford, K.

AU - Morgan, J.

AU - Ball, W.

AU - Royle, J.

AU - Lacy-Colson, J.

AU - Lai, W.

AU - Griffiths, S.

AU - Mitchell, S.

AU - Parsons, C.

AU - Joel, A.

AU - Mason, P.

AU - Harrison, G.

AU - Steinke, J.

AU - Rafique, H.

AU - Hawkins, W.

AU - Gurram, D.

AU - Hateley, C.

AU - Penkethman, A.

AU - Lambden, C.

AU - Conway, A.

AU - Dent, P.

AU - Yacob, D.

AU - Oshin, O.

AU - Hargreaves, A.

AU - Gossedge, G.

AU - Long, J.

AU - Walls, M.

AU - Futaba, K.

AU - Puig, S.

AU - Boddy, A.

AU - Jones, A.

AU - Tennuci, C.

AU - Battersby, N.

AU - Wilkin, R.

AU - Lloyd, C.

AU - Sein, E.

AU - McEvoy, K.

AU - Whisker, L.

AU - Colori, A.

AU - Sinclair, P.

AU - Loughran, M.

AU - Lawrence, A.

AU - Horsnell, J.

AU - Bagenal, J.

AU - Pisesky, A.

AU - Mastoridis, S.

AU - Solanki, K.

AU - Siddiq, I.

AU - Merker, L.

AU - Sarmah, P.

AU - Hanratty, D.

AU - Evans, L.

AU - Mortimer, M.

AU - Bhalla, A.

AU - Bartlett, D.

AU - Blencowe, N.

AU - Haddow, J.

PY - 2013/8/1

Y1 - 2013/8/1

N2 - Background Identification of variation in practice is a key step towards standardization of service and determination of reliable quality markers. This study aimed to investigate variation in provision and outcome of emergency appendicectomy. Methods A multicentre, trainee-led, protocol-driven, prospective observational cohort study was performed during May and June 2012. The main outcome of interest was the normal histopathology rate; secondary outcomes were laparoscopy and 30-day adverse event rates. Analysis included funnel plots and binary logistic regression models to identify patient- and hospital-related predictors of outcome. Results A total of 3326 patients from 95 centres were included. An initial laparoscopic approach was performed in 66·3 per cent of patients (range in centres performing more than 25 appendicectomies over the study period: 8·7-100 per cent). A histologically normal appendix was removed in 20·6 per cent of patients (range in centres performing more than 25 procedures: 3·3-36·8 per cent). Funnel plot analysis revealed that 22 centres fell below three standard deviations of the mean for laparoscopy rates. Higher centre volume, consultant presence in theatre and daytime surgery were independently associated with an increased use of laparoscopy, which in turn was associated with a reduction in 30-day morbidity (adjusted for disease severity). Daytime surgery further reduced normal appendicectomy rates. Increasing volume came at the cost of higher negative rates, and low negative rates came at the cost of higher perforation rates. Conclusion This study reveals the extremely wide variation in practice patterns and outcomes among hospitals. Organizational factors leading to this variation have been identified and should be addressed to improve performance. Appendicitis care in disgrace

AB - Background Identification of variation in practice is a key step towards standardization of service and determination of reliable quality markers. This study aimed to investigate variation in provision and outcome of emergency appendicectomy. Methods A multicentre, trainee-led, protocol-driven, prospective observational cohort study was performed during May and June 2012. The main outcome of interest was the normal histopathology rate; secondary outcomes were laparoscopy and 30-day adverse event rates. Analysis included funnel plots and binary logistic regression models to identify patient- and hospital-related predictors of outcome. Results A total of 3326 patients from 95 centres were included. An initial laparoscopic approach was performed in 66·3 per cent of patients (range in centres performing more than 25 appendicectomies over the study period: 8·7-100 per cent). A histologically normal appendix was removed in 20·6 per cent of patients (range in centres performing more than 25 procedures: 3·3-36·8 per cent). Funnel plot analysis revealed that 22 centres fell below three standard deviations of the mean for laparoscopy rates. Higher centre volume, consultant presence in theatre and daytime surgery were independently associated with an increased use of laparoscopy, which in turn was associated with a reduction in 30-day morbidity (adjusted for disease severity). Daytime surgery further reduced normal appendicectomy rates. Increasing volume came at the cost of higher negative rates, and low negative rates came at the cost of higher perforation rates. Conclusion This study reveals the extremely wide variation in practice patterns and outcomes among hospitals. Organizational factors leading to this variation have been identified and should be addressed to improve performance. Appendicitis care in disgrace

UR - http://www.scopus.com/inward/record.url?scp=84880120784&partnerID=8YFLogxK

U2 - 10.1002/bjs.9201

DO - 10.1002/bjs.9201

M3 - Article

AN - SCOPUS:84880120784

SN - 0007-1323

VL - 100

SP - 1240

EP - 1252

JO - British Journal of Surgery

JF - British Journal of Surgery

IS - 9

ER -

Multicentre observational study of performance variation in provision and outcome of emergency appendicectomy

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