English Hospital Episode Statistics Research Articles

Risks of adverse obstetric outcomes among female survivors of adolescent and young adult cancer in England (TYACSS): a population-based, retrospective cohort study

There are limited data on the risks of obstetric complications among survivors of adolescent and young adult cancer with most previous studies only reporting risks for all types of cancers combined. The aim of this study was to quantify deficits in birth rates and risks of obstetric complications for female survivors of 17 specific types of adolescent and young adult cancer. The Teenage and Young Adult Cancer Survivor Study (TYACSS)-a retrospective, population-based cohort of 200 945 5-year survivors of cancer diagnosed at age 15-39 years from England and Wales-was linked to the English Hospital Episode Statistics (HES) database from April 1, 1997, to March 31, 2022. The cohort included 17 different types of adolescent and young adult cancers. We ascertained 27 specific obstetric complications through HES among 96 947 women in the TYACSS cohort. Observed and expected numbers for births and obstetric complications were compared between the study cohort and the general population of England to identify survivors of adolescent and young adult cancer at a heighted risk of birth deficits and obstetric complications relative to the general population. Between April 1, 1997, and March 31, 2022, 21 437 births were observed among 13 886 female survivors of adolescent and young adult cancer from England, which was lower than expected (observed-to-expected ratio: 0·68, 95% CI 0·67-0·69). Other survivors of genitourinary, cervical, and breast cancer had under 50% of expected births. Focusing on more common (observed ≥100) obstetric complications that were at least moderately in excess (observed-to-expected ratio ≥1·25), survivors of cervical cancer were at risk of malpresentation of fetus, obstructed labour, amniotic fluid and membranes disorders, premature rupture of membranes, preterm birth, placental disorders including placenta praevia, and antepartum haemorrhage. Survivors of leukaemia were at risk of preterm delivery, obstructed labour, postpartum haemorrhage, and retained placenta. Survivors of all other specific cancers had no more than two obstetric complications that exceeded an observed-to-expected ratio of 1·25 or greater. Survivors of cervical cancer and leukaemia are at risk of several serious obstetric complications; therefore, any pregnancy should be considered high-risk and would benefit from obstetrician-led antenatal care. Despite observing deficits in birth rates across all 17 different types of adolescent and young adult cancer, we provide reassurance for almost all survivors of adolescent and young adult cancer concerning their risk of almost all obstetric complications. Our results provide evidence for the development of clinical guidelines relating to counselling and surveillance of obstetrical risk for female survivors of adolescent and young adult cancer. Children with Cancer UK, The Brain Tumour Charity, and Academy of Medical Sciences.

Risk of multiple sclerosis in individuals with infectious mononucleosis: a national population-based cohort study using hospital records in England, 2003-2023.

Epstein-Barr virus (EBV) is thought to be a necessary causative agent in the development of multiple sclerosis (MS). Infectious mononucleosis (IM), which occurs up to 70% of adolescents and young adults with primary EBV infection, appears to be a further risk factor but few studies have been highly powered enough to explore this association by time since IM diagnosis. The objective was to quantify the risk of MS in individuals with IM compared with the general population, with particular focus on time since IM diagnosis. In this retrospective cohort study using English national Hospital Episode Statistics from 2003 to 2023, patients with a hospital diagnosis of IM were compared with the general population for MS incidence. MS incidence in patients with IM was nearly three times higher than the general population after multivariable adjustment (adjusted hazard ratio = 2.8, 95% confidence interval (CI = 2.3-3.4), driven by strong associations at long time intervals (>5 years) between IM diagnosis and subsequent MS diagnosis. While EBV infection may be a prerequisite for MS, the disease process of IM (i.e. the body's defective immune response to primary EBV infection) seems to be, in addition, implicated over the long term.

Variation in access to specialist services for neurosurgical procedures in adults with epilepsy in England, a cohort study.

To understand if primary consultation at tertiary epilepsy centres (TEC) in England impacts access to neurosurgical procedures (resective surgery, vagus nerve stimulator [VNS], deep brain stimulator [DBS]). Adults with epilepsy, and with a first neurology outpatient visit (index) between 01/01/2013 and 31/12/2015, were followed using English Hospital Episode Statistics from index date to 31/12/2019. Analyses were stratified by geographic location, learning disability record, and whether the index or follow-up visits were at a TEC. 84,093 people were included, with mean 5.5 years of follow-up. 12.4% of the cohort had learning disability (range 10.1%-17.4% across regions). TEC consultations varied by National Health Service regions and Clinical Commissioning Groups. 37.5% of people (11.2%-75.0% across regions) had their index visit at a TEC; and, of those not initially seen at a TEC, 10.6% (6.5%-17.7%) subsequently attended a tertiary centre. During follow-up, 11.1% people (9.5%-13.2%) visited a neurosurgery department, and 2.3% of those (0.9%-5.0%) then underwent a neurosurgical procedure, mainly VNS implantation. Median time from index date to first visit at a neurosurgery centre was 7 months (range 6-8 months across regions) and 40 months to procedure (36.5-49 months, 37.0 months in people with index visit at a TEC and 49.0 months otherwise). People with learning disability were less likely to have resective surgery (<0.5% versus 1.0% in those without) and more likely to undergo VNS implantation (5.8% versus 0.8%). Although clinically recommended for suitable individuals, neurosurgical procedures in epilepsy remain uncommon even after consultation at a TEC. Geographical variation in access to TECs was present.

Comparing reported management of ureteric stones between clinical audit and administrative datasets: An opportunity to streamline clinical audit

ObjectivesTo compare recorded patient management between a clinical audit and administrative dataset for patients presenting with ureteric stones in England and to assess the feasibility of using administrative data for routine audit. Patients and methodsThe British Association of Urological Surgeons conducted a clinical audit of all patients presenting as an emergency to 107 hospitals in England during November 2020 with ureteric stones. All patients were followed up until 31st March 2021 and in-patient and out-patient management received recorded. These clinical audit data were compared to those available from the English Hospital Episode Statistics (HES) administrative database covering the same time period. ResultsData were available for 2344 patients from HES, and 2050 patients admitted to the same 107 hospitals from clinical audit. The two cohorts were well matched for age (mean 47.2 years and 49.3 years respectively), but with a higher proportion of females in the HES dataset (42.2 % vs 30.1 %). Recorded treatment received was similar in both cohorts, other than for ureteroscopy, which was significantly under recorded in HES, most obviously following initial stent placement (17.2 % vs 26.0 % ureteroscopy as final management respectively). ConclusionsThe two data sources were generally well matched in terms of patient numbers, age and management. The higher number of patients and females in HES may be due to initial misdiagnosis of abdominal pain as ureteric stones in females. The reasons for discrepancies in recording of ureteroscopy are unclear and warrant further investigation. Administrative data can complement clinical audit data and streamline the audit process, but issues around data quality should be studied prior to use of administrative data for this purpose.

Impact of gender, ethnicity and social deprivation on access to surgical or transcatheter aortic valve replacement in aortic stenosis: a retrospective database study in England

ObjectiveTo assess gender, ethnicity, and deprivation-based differences in provision of aortic valve replacement (AVR) in England for adults with aortic stenosis (AS).MethodsWe retrospectively identified adults with AS from the English...

Real world safety of methoxyflurane analgesia in the emergency setting: a comparative hybrid prospective-retrospective post-authorisation safety study

BackgroundLow-dose analgesic methoxyflurane (Penthrox®) was approved in Europe for emergency relief of moderate to severe pain in conscious adults with trauma in 2015. A comparative post-authorisation safety study (PASS) was conducted to assess the risk of hepatotoxicity and nephrotoxicity with methoxyflurane during routine clinical practice.MethodsThis was a comparative hybrid prospective-retrospective cohort study. The comparative cohorts consisted of adults who were given methoxyflurane (methoxyflurane cohort) or another analgesic (concurrent cohort) routinely used for moderate to severe trauma and associated pain in the emergency setting (ambulance and Emergency Department) in the UK between December 2016 and November 2018. Hepatic and renal events were captured in the ensuing 12 weeks. A blinded clinical adjudication committee assessed events. A historical comparator cohort (non-concurrent cohort) was identified from patients with fractures in the English Hospital Episode Statistics (HES) accident and emergency database from November 2013 and November 2015 (before commercial launch of methoxyflurane). Hepatic and renal events were captured in the ensuing 12 weeks via linkage with the Clinical Practice Research Datalink (CPRD) and HES hospital admissions databases.ResultsOverall, 1,236, 1,101 and 45,112 patients were analysed in the methoxyflurane, concurrent and non-concurrent comparator cohorts respectively. There was no significant difference in hepatic events between the methoxyflurane and concurrent cohorts (1.9% vs. 3.0%, P = 0.079) or between the methoxyflurane and non-concurrent cohorts (1.9% vs. 2.5%, P = 0.192). Renal events were significantly less common in the methoxyflurane cohort than in the concurrent cohort (2.3% vs. 5.6%, P < 0.001). For methoxyflurane versus non-concurrent cohort the lower occurrence of renal events (2.3% vs. 3.2%, P = 0.070) was not statistically significant. Multivariable adjustment did not change these associations.ConclusionsMethoxyflurane administration was not associated with an increased risk of hepatotoxicity or nephrotoxicity compared with other routinely administered analgesics and was associated with a reduced risk of nephrotoxicity compared with other routinely administered analgesics.Trial registrationStudy registered in the EU PAS Register (ENCEPP/SDPP/13040).

P17 Baseline characteristics, disease progression rates and risk factors among female patients with uncomplicated urinary tract infection in England

Abstract Background and Objectives Uncomplicated urinary tract infection (uUTI) is a common, usually community-acquired bacterial infection. Little is known about risk factors for disease progression (defined here as hospitalization for Escherichia coli sepsis, bacteraemia or acute pyelonephritis) among patients with uUTI. We report the baseline demographic and clinical characteristics among female uUTI patients with/without disease progression in England. Methods This retrospective cohort study utilized anonymized patient data from 1 January 2018 to 31 December 2019 from the Clinical Practice Research Datalink (CPRD) database linked to English Hospital Episode Statistics data. Eligible patients were female, aged ≥12 years, had received an index diagnosis for a community-acquired uUTI, had ≥12 months’ CPRD data history, and had received ≥1 oral antibiotic within ±5 days of diagnosis. Patients were excluded if they had complicated UTI or complicating comorbidities, were hospitalized/visited an accident and emergency department 28 days prior to index or had received IV antibiotics as initial therapy. uUTI episodes were defined as the 28 days post-index (Figure 1). Descriptive patient (demographic and clinical characteristics), region and practice-level characteristics in the 12 month baseline period are presented for patients with/without disease progression. Figure 1.Study design. HES, Hospital Episode Statistics. Results Among 116793 female patients with a uUTI, 207 were hospitalized for E. coli sepsis, bacteraemia or acute pyelonephritis within 28 days of index (0.2%). The mean age (SD) for patients with/without progression was 67.3 (20.2) and 52.9 (21.1), respectively; 81% and 34% of patients with/without progression were ≥50 years old. Imbalances were observed for comorbid burden, baseline medications, initial presentation (i.e. home visit requirement) and prior antimicrobial treatment (Table 1). Few regional or practice-level differences were apparent (Table 1). Table 1.Patient (demographic and clinical characteristics), region and practice-level variable distribution between uUTI patients without and with hospitalization for uUTI disease progressionVariable description/Statistic or categoryPatient subgroupsno disease progression (N=116586)disease progression (N=207)N%N%Patient-level Age at diagnosis, years, mean (SD)52.9 (21.1)–67.3 (20.2)– Age at diagnosis ≥12 to &amp;lt;167110.600 ≥16 to &amp;lt;301986117157.2 ≥30 to &amp;lt;401668214136.3 ≥40 to &amp;lt;501518413115.3 ≥50 to &amp;lt;6024512214220 ≥65396363412661 Age at diagnosis (pooled) &amp;lt;5052438453919 ≥50396363416881 Charlson comorbidity index, mean (IQR)0 (0, 0)–0 (0, 1)– Charlson comorbidity category 0959448213465 118007155828 223002125.8 ≥33350.3&amp;lt;5 Race/ethnicity, N (%) Asian or Asian British51614.462.9 Black or Black British32872.862.9 Chinese or other group19951.7&amp;lt;5- Ethnic group not recorded22781204321 White41340357335 Number of hospital admissions in prior year, mean (IQR)0 (0, 0)–0 (0, 0)– Number of A&amp;E attendances in prior year, mean (IQR)0 (0, 1)–0 (0, 1)– Smoking status Non-smoker725466211957 Ex-smoker27084236230 Smoker16956152613 Menopausal status, yes34072296029 Obesity, yes13858123316 Mild/moderate renal impairment, yes22621.9104.8 Controlled diabetes (HgA1C &amp;lt;6.5/7%), yes24512.1146.8 History of recurrent uUTI, yes49374.2115.3 Prior antimicrobial treatment (any), yes702746015072 Cumulative antimicrobial prescriptions, median (IQR)1 (0, 2)–&amp;lt;5–Region-level Quintiles of index of multiple deprivation Q1 (least deprived)26869234220 Q223597203919 Q322273193818 Q422085194622 Q5 (most deprived)21762194220 Rural-urban area classification Rural15416133014 Urban1011708717786Practice-level Practice size Small (&amp;lt;8000 patients)30783265627 Medium (8000–11000 patients)25377224421 Large (&amp;gt;11000 patients)604265210752Percentage values do not add up to 100% for ethnicity as these data were not available for all patients and mixed ethnicity is not shown due to limited interpretability.A&amp;E, accident and emergency; HgA1C, glycated haemoglobin; Q, quintile. Conclusions Hospitalization following uUTI is rare in this study, however, at a population level, this still affects a large number of female patients. Coding limitations meant potentially linked admissions (e.g. falls and confusion) could not be identified. Hospitalizations appear to be driven by patient factors rather than regional differences or practice patterns. The role of these putative risk factors for disease progression will be explored further via multivariable logistic regression analysis.

P19 Burden of illness and costs among female patients with uncomplicated urinary tract infection in England

Abstract Background and Objectives Uncomplicated urinary tract infection (uUTI) is usually community-acquired. Data regarding the wider burden of illness from uUTI are scarce. We evaluated the burden of uUTI in female patients in England. Methods This retrospective comparative cohort study utilized linked anonymized patient data from 1 January 2017 to 29 February 2020 from the Clinical Practice Research Datalink (CPRD) and English Hospital Episode Statistics databases. All eligible patients were female, aged ≥12 years and had ≥12 months’ CPRD data available pre- and post-index (i.e. ≥24 months total). Patients with an index UTI diagnosis who had received ≥1 oral antibiotic within ±5 days of index formed the uUTI cohort; uUTI episodes were defined as 28 days from index diagnosis. Patients who had visited a primary care setting but did not have a UTI (uUTI or complicated UTI [cUTI]) diagnosis during the study period formed the control cohort and were matched to the index date of uUTI patients. Patients who were hospitalized or visited an accident and emergency department 28 days prior to index, had cUTI and/or had received IV antibiotics as initial therapy were excluded. Burden of illness (index/12 month follow-up all-cause and UTI-related healthcare resource use [HCRU] and costs) was evaluated in a 1:1 age- and Charlson Comorbidity Index (CCI) score-matched cohort. Results Overall, 120519 female patients with uUTI and 233670 female control patients (without uUTI) were identified and matched 1:1. Before matching, more of the uUTI cohort patients versus controls were &amp;lt;50 years old, had a higher mean CCI score, and were more often menopausal; region- and practice-level differences were modest (Table 1). HCRU and costs were significantly higher among uUTI patients versus matched controls, notably for primary care, specialist, and accident and emergency visits, and hospital admissions (P&amp;lt;0.001, Table 2). After adjusting for patient characteristics, Poisson or negative binomial models showed significant HCRU differences in primary and secondary care for uUTI patients versus matched controls (Table 3). Conclusions Patients with uUTI in England had significantly higher burden of illness, consuming more resources, during index uUTI episodes and follow-up, versus matched controls.

P18 Treatment patterns and extent of inappropriate antimicrobial treatment among female patients with uncomplicated urinary tract infection in England

P18 Treatment patterns and extent of inappropriate antimicrobial treatment among female patients with uncomplicated urinary tract infection in England

Comparison of outcomes for patients with and without a serious mental illness presenting to hospital for chronic obstruction pulmonary disease: retrospective observational study using administrative data.

There are few data on the profile of those with serious mental illness (SMI) admitted to hospital for physical health reasons. To compare outcomes for patients with and without an SMI admitted to hospital in England where the primary reason for admission was chronic obstructive pulmonary disease (COPD). This was a retrospective, observational analysis of the English Hospital Episodes Statistics data-set for the period from 1 April 2018 to 31 March 2019, for patients aged 18-74 years with COPD as the dominant reason for admission. Patient with an SMI (psychosis spectrum disorder, bipolar disorder) were identified. Data were available for 54 578 patients, of whom 2096 (3.8%) had an SMI. Patients with an SMI were younger, more likely to be female and more likely to live in deprived areas than those without an SMI. The burden of comorbidity was similar between the two groups. After adjusting for covariates, SMI was associated with significantly greater risk of length of stay than the median (odds ratio 1.24, 95% CI 1.12-1.37, P ≤ 0.001) and with 30-day emergency readmission (odds ratio 1.51, 95% confidence interval 1.34-1.69, P ≤ 0.001) but not with in-hospital mortality. Clinicians should be aware of the potential for poorer outcomes in patients with an SMI even when the SMI is not the primary reason for admission. Collaborative working across mental and physical healthcare provision may facilitate improved outcomes for people with SMI.

Association between outpatient follow-up and incidence of revision after knee and hip replacements: a population-based cohort study

BackgroundFollow-up visits 5 or 7 years after surgery were recommended for people having primary hip or knee replacement. The benefits of this practice to patients and the healthcare system, however, have not yet been specifically examined. The aim of this study was to investigate the association between long-term follow-up outpatient hospital visits and revision rates for patients who undergo primary knee or hip replacement surgery.MethodsCohorts were identified for patients undergoing knee or hip replacement surgery using medical records from primary care practices within the UK Clinical Practice Research Datalink (CPRD) GOLD dataset linked to hospital records from the English Hospital Episodes Statistics (HES) data. Two groups of patients were compared in terms of revision and mortality rates: those with at least one long-term (between five and 10 years since primary surgery) follow-up visit at the orthopaedic department (‘Follow-up’ group), and those without (‘No follow-up’ group).ResultsA total of 9856 (4349 in the Follow-up group) patients with knee replacement and 10,837 (4870 in the Follow-up group) with hip replacement were included in the analysis. For knee replacement, the incidence of revision was 3.6% for those followed-up and 0.6% for those not followed-up. An adjusted regression model confirmed the difference in the hazard ratio (HR) for revision was statistically significant (HR: 5.65 [95% CI 3.62 to 8.81]). Mortality at 4 years was lower for the Follow-up (17%) compared to the No follow-up group (21%), but this difference was not statistically significant (HR: 0.95 [0.84 to 1.07]). For hip replacement, the incidence of revision rates were 3.2 and 1.4% for the follow-up and not follow-up groups, respectively, the difference being statistically significant (HR: 2.34 [1.71 to 3.20]). Mortality was lower for the Follow-up (15%) compared to the No follow-up group (21%), but the difference was not statistically significant (HR: 0.91 [0.81 to 1.02]).ConclusionPatients attending follow-up orthopaedic consultations show a higher risk of revision surgery compared to those who are not followed-up. A cause for this difference could not be identified in this study but a likely explanation is that surgeons play an effective role as ultimate arbitrators when identifying patients to be included in long-term follow-up lists.

Data consistency in the English Hospital Episodes Statistics database

BackgroundTo gain maximum insight from large administrative healthcare datasets it is important to understand their data quality. Although a gold standard against which to assess criterion validity rarely exists for...

Hospitalization costs of adult community-acquired pneumonia in England

Objective Accurate and up-to-date figures of the cost of community-acquired pneumonia (CAP) hospitalization are needed to understand the associated economic burden for public health decision-makers. Recent estimates are lacking, and previously published estimates differ markedly. Our objective was to estimate the current mean cost to the UK National Health Service (NHS) for adult hospitalized CAP. Methods All CAP hospitalizations in 2019 for those aged ≥18 years were identified from English Hospital Episode Statistics (HES). Each hospitalization was mapped to the tariff cost paid to the care provider within the NHS, including critical care costs and accounting for length of stay and complexity of the case. Mean hospitalization costs were estimated in total and in individuals with defined underlying comorbidities. Results A mean cost of £3,904 was estimated for 187,251 CAP admissions providing a total cost of approximately £731 million per annum. The mean cost was £3,402, excluding critical care costs, and £11,654 for critical care episodes in the 4.4% of admissions receiving this care. Groups at high risk of CAP had higher mean costs, ranging from £4,458 for people with diabetes to £5,215 for those with heart disease aged <65 years and £4,356 for those with heart disease to £4,751 for those with liver disease aged >65 years who comprised 74.3% of admissions overall. Conclusion This estimate of the cost of hospitalization for CAP from the total population and in those with certain underlying comorbidities will allow a valid understanding of the cost-benefit of vaccination and evidence-based prioritization of pneumococcal vaccination to those at highest risk.

Primary care consultations and pain medicine prescriptions: a comparison between patients with and without chronic pain after total knee replacement

BackgroundApproximately 20% of patients experience chronic pain after total knee replacement (TKR). The impact of chronic pain after TKR on primary care services in the UK is currently unknown. The aim of this study was to compare primary care consultations and pain medicine prescriptions between patients with and without chronic pain after TKR.MethodsData from 5,055 patients who received TKR between 2009 and 2016 with anonymised linked data from the Clinical Practice Research Datalink Gold (CPRD) and English Hospital Episode Statistics (HES) Patient Reported Outcome Measures (PROMs) programme were analysed. The exposure time was from 10 years pre-operative to eight years post-operative. Patients with a score ≤ 14 on the Oxford Knee Score pain component scale at 6 months post-operative were classified as having chronic pain after TKR. Primary care consultations and prescribed pain medicines were quantified, and costs calculated based on national cost data.Results721 patients (14%) had chronic pain after TKR. The prevalence and costs of primary care consultations and pain medicine prescriptions per year were consistently higher for patients with chronic pain after TKR compared with those without chronic pain after TKR; these differences were observed both before and after surgery. There was a substantial and sustained increase in the cost of opioid prescriptions after surgery for patients with chronic pain after TKR, peaking at seven years post-operative.ConclusionsIncreased primary care consultations and pain medicine prescriptions associated with chronic pain after TKR represent a considerable financial cost to primary care services. Evaluation of interventions to reduce the risk of developing this pain condition and improve the early management of pain after TKR are needed to improve outcomes for patients and reduce costs to healthcare services.

A matched comparison of cementless unicompartmental and total knee replacement outcomes based on the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man.

Background and purposeThe main treatments for severe medial compartment knee arthritis are unicompartmental (UKR) and total knee replacement (TKR). UKRs have higher revision rates, particularly for aseptic loosening, therefore the cementless version was introduced. We compared the outcomes of matched cementless UKRs and TKRs.Patients and methodsThe National Joint Registry was linked to the English Hospital Episode Statistics and Patient Reported Outcome Measures (PROMs) databases. 10,552 cementless UKRs and 10,552 TKRs were propensity matched and regression analysis used to compare revision/reoperation risks. 6-month PROMs were compared. UKR results were stratified by surgeon caseload into low- (< 10 UKRs/year), medium- (10 to < 30 UKRs/year), and high-volume (≥ 30 UKRs/year).Results8-year cementless UKR revision survival for the 3 respective caseloads were 90% (95% CI 87–93), 93% (CI 91–95), and 96% (CI 94–97). 8-year reoperation survivals were 76% (CI 71–80), 81% (CI 78–85), and 84% (CI 82–86) respectively. For TKR the 8-year implant survivals for revision and reoperation were 96% (CI 95–97) and 81% (CI 80–83). The HRs for the 3 caseload groups compared with TKR for revision were 2.0 (CI 1.3–2.9), 2.0 (CI 1.6–2.7), and 1.0 (CI 0.8–1.3) and for reoperation were 1.2 (CI 1.0–1.4), 0.9 (CI 0.8–1.0), and 0.6 (CI 0.5–0.7). 6-month Oxford Knee Score (OKS) (39 vs. 37) and EQ-5D (0.80 vs. 0.77) were higher (p < 0.001) for the cementless UKR.InterpretationCementless UKRs have higher revision and reoperation rates than TKR for low-volume UKR surgeons, similar reoperation but higher revision rates for mid-volume surgeons, and lower reoperation and similar revision rates for high-volume surgeons. Cementless UKR also had better PROMs.

Major variation in hepatocellular carcinoma treatment and outcomes in England: a retrospective cohort study

ObjectiveHepatocellular carcinoma (HCC) is increasingly incident in England, while survival remains poor with regional disparities. We aimed to explore the differences in HCC treatment across different geographical regions and to...

UK poSt Arthroplasty Follow-up rEcommendations (UK SAFE): what does analysis of linked, routinely collected national datasets tell us about mid–late term revision risk after knee replacement?

ObjectiveTo identify patients at risk of mid-late term revision of knee replacement (KR) to inform targeted follow-up.DesignAnalysis of linked national datasets from primary and secondary care (Clinical Practice Research Datalink...

UK poSt Arthroplasty Follow-up rEcommendations (UK SAFE): what does analysis of linked, routinely collected national data sets tell us about mid-late term revision risk after hip replacement? Retrospective cohort study

ObjectiveTo identify patients at risk of mid-late term revision of hip replacement to inform targeted follow-up.DesignAnalysis of linked national data sets from primary and secondary care (Clinical Practice Research Datalink...

Survival outcomes for right-versus left-sided colon cancer and rectal cancer in England: A propensity-score matched population-based cohort study

IntroductionThe aim of this study was to evaluate 5-year overall survival (OS) in patients operated on for potentially curable right versus left-sided colon cancer and rectal cancer in England. Materials and methodsA retrospective propensity-score matched population-based cohort study was performed using data from English Hospital Episode Statistics, Office for National Statistics and National Bowel Cancer Audit dataset. Patients ≥18 who underwent elective resection for right-colon, left-colon, or rectal cancer between 2000 and 2015 were included. Patients were matched using propensity scores with the dependant variable being site of primary tumour (right-colon, left-colon, or rectum) and independent variables age, Charlson comorbidity index, operation year and Duke's stage. The primary outcome was 5-year overall survival (OS). ResultsA total of 167,606 patients were included. Following propensity-score matching 26,662 patients remained in each group (right-colon, left-colon, and rectum). 5-year OS was significantly worse for patients with Duke's A-C right-sided primaries compared to left-sided and rectal cancers in the unmatched (58.8% vs 66.7% vs 70.0% p=<0.001) and matched cohorts (62.6%, 66.8%, 65.8% p=<0.001). Superior OS for patients with left-sided colon cancer was demonstrated across all stages (Duke's A HR 0.845, p = 0.003; Duke's B HR 0.947, p = 0.045; Duke's C HR 0.783, p < 0.0001). Secondary analysis demonstrated equivalent OS between study groups when ≥22 lymph nodes were harvested. ConclusionThere is a significant difference in survival between comparable patients with right and left sided colon cancers in England. The quality and/or extent of mesenteric resection may be of particular importance in right-sided colon cancer.

Evaluation of the Ventral Hernia Working Group classification for long-term outcome using English Hospital Episode Statistics: a population study

PurposeThe Ventral Hernia Working Group (VHWG) classification of ventral/incisional hernia (IH) was developed by expert consensus in 2010. Subsequently, Kanters et al. have demonstrated the validity of a modified version of the system for predicting short-term outcomes. This study aims to evaluate the modified system for predicting hernia recurrence.MethodsPatients undergoing IH surgery (defined by OPCS codes) in the England Hospital Episode Statistics (HES) database, from 1997 to 2012, were identified. Baseline demographics at index hernia operation and episodes of further hernia surgery (FHS) were recorded. Risk factors for FHS were identified using cox regression and evaluated against the modified-VHWG grade using receiver-operating characteristics (ROC).ResultsThe final analysis included 214,082 index IH operations. Of these, 52.6% were female and mean age was 56.59 (SD15.9). An admission for FHS was found in 8.3% cases (17,714 patients).Multi-variate cox regression revealed contaminated hernia (p < 0.0001), pre-existing IBD (p < 0.0001) and hernia comorbidity (p = 0.05) to be significantly related to long-term FHS. Classifying patients using these factors, according to the modified-VHWG classification, revealed that compared to Grade 1, the hazard ratio (HR) of FHS increased in Grade 2 (HR 1.19; p < 0.0001) and further increased in Grade 3 (HR 1.79; p < 0.0001). ROC analysis revealed the area under the curve to be 0.73 (95% CI 0.73–0.74).ConclusionThis analysis demonstrates the broad validity of the modified-VHWG classification in discriminating risk for FHS. Inclusion of pre-existing IBD as a factor defining Grade 2 patients would be recommended. This analysis is limited by the absence of certain factors within the HES database, such as BMI.