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Biomedical subjects

Alex Bottle

Publications and source records attributed to Alex Bottle.

At least 19 recordsLinked to original sources
PubMed2006

Mortality associated with delay in operation after hip fracture: observational study.

OBJECTIVE: To estimate the number of deaths and readmissions associated with delay in operation after femoral fracture. DESIGN: Analysis of inpatient hospital episode statistics. SETTING: NHS hospital trusts in England with at least 100 admissions for fractured neck of femur during the study period. Patients People aged > or = 65 admitted from home with fractured neck of femur and discharged between April 2001 and March 2004. MAIN OUTCOME MEASURES: In hospital mortality and emergency readmission within 28 days. RESULTS: There were 129,522 admissions for fractured neck of femur in 151 trusts with 18,508 deaths in hospital (14.3%). Delay in operation was associated with an increased risk of death in hospital, which was reduced but persisted after adjustment for comorbidity. For all deaths in hospital, the odds ratio for more than one day's delay relative to one day or less was 1.27 (95% confidence interval 1.23 to 1.32) after adjustment for comorbidity. The proportion with more than two days' delay ranged from 1.1% to 62.4% between trusts. If death rates in patients with at most one day's delay had been repeated throughout all 151 trusts in this study, there would have been an average of 581 (478 to 683) fewer total deaths per year (9.4% of the total). There was little evidence of an association between delay and emergency readmission. CONCLUSIONS: Delay in operation is associated with an increased risk of death but not readmission after a fractured neck of femur, even with adjustment for comorbidity, and there is wide variation between trusts.

Age Factors↗
PubMed2006

Identifying patients at high risk of emergency hospital admissions: a logistic regression analysis.

OBJECTIVE: To use routine data to identify patients at high risk of future emergency hospital admissions. DESIGN: Descriptive analysis of inpatient hospital episode statistics. Predictive model developed using multiple logistic regression. SETTING: National Health Service hospital trusts in England. PARTICIPANTS: All patients with an emergency admission to an NHS hospital between 1 April 2000 and 31 March 2001. MAIN OUTCOME MEASURES: 'High-impact users' were defined as patients who had at least one emergency inpatient admission and who then went on to have at least two further emergency hospital admissions in the 12 months following the start date of that index admission. RESULTS: 2,895,234 patients were admitted as emergencies in 2000/2001, of whom 147,725 (5.1%) did not survive their first spell. Of the 2,747,509 surviving patients, 269,686 (9.8%) subsequently had at least two or more emergency admissions within 365 days of the index date of admission. A further 236,779 (8.6%) died during this period. Risk factors for becoming a high-impact user included the number of emergencies in the 36 months before index spell, comorbidity, age, an admission for an ambulatory care sensitive condition, ethnicity, area-level socioeconomic data, local admission rates, the number of episodes in the index spell, sex and the source of admission. The predictive model based on all emergency admissions produced a receiver operating characteristic curve score of 0.72. CONCLUSIONS: Routine hospital episode statistics can be used to identify patients who are at high risk of suffering future multiple emergency hospital admissions. The potential cost savings in preventing a proportion of these subsequent admissions need to be compared with the costs of case management of these patients.

Adolescent↗
PubMed2005

Variations in vaginal and abdominal hysterectomy by region and trust in England.

OBJECTIVE: To examine variations between regions and hospitals in the proportion of hysterectomies performed abdominally. DESIGN: Analysis of routine hospital data. SETTING: All National Health Service hospitals in England. POPULATION: Women aged 18+ hospitalised between April 1998 and March 2001. METHODS: Logistic regression, adjusting for age and diagnosis. MAIN OUTCOME MEASURE: Use of the abdominal rather than the vaginal route. RESULTS: The adjusted proportion of hysterectomies performed abdominally varied from 75-89% between regions, and from 25-99% between hospitals. Diagnosis accounted for nearly a third of the total variation, dwarfing the contributions of age and hospital. About two-thirds of the variation remained unaccounted for. CONCLUSION: Despite evidence suggesting that the majority of hysterectomies may be performed vaginally, very few English trust match this.

Adolescent↗
PubMed2004

Controlling for provider of treatment in the modelling of respiratory disease risk near cokeworks.

The improved quality of hospital admissions data makes them a valuable resource for researchers. However, we show that, when multiple providers of health care are considered, the provider (in this case hospital) may act like other confounders such as socio-economic status, and hence must be controlled for. Such control is not as straightforward as for conventional confounders, however, but we describe a method that is appropriate under certain assumptions. We also describe a number of other statistical issues, such as the modelling of spatial and non-spatial overdispersion, that arose during the use of hospital data in a study to investigate the possible adverse health effects of living in proximity to six cokeworks groups in England and Wales. The outcome data that we consider consist of hospital admissions for all respiratory disease in the under-5s. The ecological level of the analysis is the census-defined enumeration district, and the main (proxy) exposure measure utilised is the spatial location of the enumeration district population-weighted centroid in relation to the cokeworks. We focus on the Teesside cokeworks group, for which we also had sulphur dioxide measurements from dispersion modelling as an alternative exposure measure. The major local providers varied appreciably in their standardized admission ratios for respiratory disease, and when provider was controlled for, the size of the observed excess risk found close to the cokeworks was decreased, making control for the provider of health care vital. However, the presence of multiple pollution sources, in addition to the usual shortcomings of ecological studies, makes interpretation difficult.

Air Pollutants↗
PubMed2004

Paediatric cardiac surgical mortality in England after Bristol: descriptive analysis of hospital episode statistics 1991-2002.

OBJECTIVE: To describe trends in mortality of open cardiac surgery in children in Bristol and England since 1991. DESIGN: Retrospective analysis of hospital episode statistics data. SETTING: All open cardiac surgery of children in England. POPULATION: Patients younger than 16 undergoing open cardiac surgical procedures in England between April 1991 and March 2002. Three time periods were defined: epoch 3 (April 1991 to March 1995), epoch 5 (April 1996 to March 1999), epoch 6 (April 1999 to March 2002). MAIN OUTCOME MEASURE: Mortality in hospital within 30 days of a cardiac procedure. RESULTS: We identified 5221 open operations between April 1996 and March 2002 in children under 1 year and 6385 in children aged 1-15 years. Mortality for all centres combined fell from 12% in epoch 3 to 4% in epoch 6. Mortality in children under 1 year at Bristol fell from 29% (95% confidence interval 21% to 37%) in epoch 3 to 3% (1% to 6%) in epoch 6, below the national average. The reduction in mortality did not seem to be due to fewer high risk procedures or an increase in the numbers of low risk cases. Oxford had a significantly higher mortality than the national average in all three epochs (11% (5% to 18%) in epoch 6), which was not affected by adjusting for procedure or the inclusion of cases with missing outcomes. CONCLUSIONS: At Bristol, mortality for open operations in children aged under 1 year has fallen markedly, to below the national average. Nationwide mortality has also fallen. Improved quality of care may account for the drop in mortality, through new technologies or improved perioperative and postoperative care, or both.

Adolescent↗