Hospital Episode Statistics Data Research Articles

Biliary Tract and Liver Complications in Polycystic Kidney Disease.

Polycystic liver disease is a well described manifestation of autosomal dominant polycystic kidney disease (ADPKD). Biliary tract complications are less well recognized. We report a 50-year single-center experience of 1007 patients, which raised a hypothesis that ADPKD is associated with biliary tract disease. We tested this hypothesis using all England Hospital Episode Statistics data (1998-2012), within which we identified 23,454 people with ADPKD and 6,412,754 hospital controls. Hospitalization rates for biliary tract disease, serious liver complications, and a range of other known ADPKD manifestations were adjusted for potential confounders. Compared with non-ADPKD hospital controls, those with ADPKD had higher rates of admission for biliary tract disease (rate ratio [RR], 2.24; 95% confidence interval [95% CI], 2.16 to 2.33) and serious liver complications (RR, 4.67; 95% CI, 4.35 to 5.02). In analyses restricted to those on maintenance dialysis or with a kidney transplant, RRs attenuated substantially, but ADPKD remained associated with biliary tract disease (RR, 1.19; 95% CI, 1.08 to 1.31) and perhaps with serious liver complications (RR, 1.15; 95% CI, 0.98 to 1.33). The ADPKD versus non-ADPKD RRs for biliary tract disease were larger for men than women (heterogeneity P<0.001), but RRs for serious liver complications appeared higher in women (heterogeneity P<0.001). Absolute excess risk of biliary tract disease associated with ADPKD was larger than that for serious liver disease, cerebral aneurysms, and inguinal hernias but less than that for urinary tract infections. Overall, biliary tract disease seems to be a distinct and important extrarenal complication of ADPKD.

Supplementing linked datasets with meaningful meta-data to enable high quality research

ABSTRACTObjectivesEnable high quality research using linked data sources whose membership and coverage change over time by providing clarity in applied processing steps and meaningful meta-data.&#x0D; ApproachOur organisations have developed a process that enables linkage of primary care practice data to several disparate data sets. Identifiers are submitted to the trusted third party (TTP) organisation by consenting practices and external data controllers. These include patient NHS number, post code, date of birth and gender. The TTP remove duplicates and clean the data received, and use a sequential eight stage deterministic algorithm to match patients based on all or some of the identifiers. The TTP provide the research organisation with meta-data; a match rank variable per linked dataset to indicate at which stage in the matching algorithm the patient was matched, as well as flags to indicate whether the identifiers submitted by the practice were valid.&#x0D; As part of the research organisation’s standard linked data provision, only patients that have a valid NHS number in the practice data, and therefore have the potential to be linked on NHS number are identified as eligible. A flag to indicate eligibility per individual linked data source is provided. Individual data source coverage periods allow users to define follow-up time for patients. Individuals that have contributed data to more than one practice are flagged. Records for patients that have not been matched on NHS number, or who have been linked to multiple individuals in the linked dataset are removed. This together with recommendations provided in the documentation simplifies decision making for applied research. Methodological research is supported through the option to access removed records.&#x0D; ResultsIn the latest linkage set, identifiers for 10,272,602 patients from 404 English GP practices were collected by the TPP. Of these, 8,213,068 (80%) had a valid NHS flag. A total of 7,401,948 patients were found to have one or more records in Hospital Episodes Statistics (HES) data: 7,152,194 (97%) were matched on NHS number and 6,661,453 (93%) were identified as unique HES patients.&#x0D; ConclusionTo maximise research benefit from linked data, study designs must account for linkage methodologies and potential errors. Data providers need to support informed decision making for applied research whilst enabling methodological research that explores linkage validity and related biases. The documentation and meta-data that we provide enables users to make informed decisions about their study based on its context and design.

The impact of cycle proficiency training on cycle-related behaviours and accidents in adolescence: findings from ALSPAC, a UK longitudinal cohort

ABSTRACT&#x0D; ObjectivesIn the UK, some children undertake National Cycle Proficiency Scheme [NCPS]/Bikeability training in primary school. It aims to promote cycling and safe cycling behaviours but there has been little scientific evaluation of its effectiveness. We aimed to examine the impact of cycle training on cycle-related behaviours and accidents in adolescence using self-report and hospital episode statistics (HES) data.&#x0D; ApproachThe sample (n=5415) were participants in the Avon Longitudinal Study of Parents and Children who reported whether or not they had received NCPS training. Self-reported outcomes at 14 and 16 years included: cycling to school, ownership of cycle helmet, use of cycle helmet and high-visibility clothing on last cycle, and involvement in a cycle accident. Hospital admittance due to a cycle accident from 11-16 years was also included for a subsample (n=2222) who have been linked to HES. The association between cycle training and each of the outcomes was analysed using multilevel logistic regression (individual level 1, school level 2 [pseudo-ID of school attended obtained from linkage to National Pupil Database]), adjusted for a range of potential confounders.&#x0D; ResultsApproximately 40% had received NCPS training. At 14 and 16 years, trained children were more likely to cycle to school (at 16 years: adjusted OR 1.56, 95% CI 1.20-2.02) and to own a helmet (16 years: 2.03, 1.72-2.41) than those who had not attended a course. They were also more likely to have worn a helmet on their last cycle at age 14 (1.26, 1.07-1.49), and to have worn high-visibility clothing at age 16 (1.70, 1.22-2.39). Training was not associated with self-reported involvement in a cycle accident, and only six participants with HES data had been admitted to hospital due to a cycle accident. Irrespective of training, results indicate very low use of high-visibility clothing (5%), very few girls cycling to school (&lt;2%), and less than half of helmet owners wearing one on their last cycle. Ownership and use of helmets was particularly low in children from lower socio-economic position families.&#x0D; ConclusionCycle training for children can have benefits that persist into adolescence. However, the low use of cycle helmets and high-visibility clothing indicate the further potential for interventions to encourage safe cycling behaviours in young people. Our hospital admissions outcome only captures individuals who sustained serious injuries; more minor cycle injuries would have been treated in A&amp;E but a lack of detail in admission codes precludes analysis of such data.

Outcomes in Paediatric Intensive Care Units for Children with Life-Limiting Conditions: A national data linkage study

ABSTRACT&#x0D; ObjectiveTo identify children with a Life-Limiting Condition (LLC) who have had an admission to a Paediatric Intensive Care Unit (PICU) in England and their outcomes.&#x0D; ApproachData for all children who had had a PICU admission in the UK between 1st Jan 2004 and 31st March 2015 were identified from the PICANet dataset.&#x0D; Linkage to inpatient Hospital Episode Statistics (HES) data was undertaken by the NHS Health and Social Care Information Centre for all children who had been resident in England. Their standard algorithm using NHS number, date of birth, sex and postcode was used. All inpatient HES episodes from the financial years 1997/98-2014/15 were received.&#x0D; Although the data quality is high in the PICANet dataset, comorbidities are variably coded therefore identifying whether a child has a LLC or not is not possible. A previously developed ICD10 coding framework was used to identify individuals with one or more of these LLC codes in the inpatient HES dataset.&#x0D; ResultsA total of 199,548 PICU admissions in the UK for 135,759 individuals occurred during the time period of the study. Data for 43,565 admissions (32,025 individuals) were excluded due to not having been resident in England or poor quality demographic data.&#x0D; Data on 103,734 individuals (155,983 admissions) were sent for linkage. Successful linkage occurred in 102,722 individuals (99.4%). Individuals who could not be linked were excluded from the analysis.51.0% of these children had a LLC and these children accounted for 62.7% of the PICU admissions.&#x0D; The crude PICU death rate in the children with a LLC was 5.0% (n=4826) compared to 3.1% (n=1786) in those without a LLC. The OR of death in a model adjusted for diagnostic group, sex, age, and expected risk of mortality for children with a LLC was 2.11 (95%CI 1.97-2.27).&#x0D; ConclusionsChildren with a LLC account for a large proportion of all PICU admissions in England. Although only one in twenty of these children die in PICU, as death may be expected in this population of children more integration of specialist palliative care with PICU services may allow more choice for children and families.

Requirements for and current provision of rehabilitation services for children after severe acquired brain injury in the UK: a population-based study

ObjectivesSurvival with brain injury is an outcome of severe illness that may be becoming more common. Provision for children in this situation has received little attention. We sought to estimate...

Short-term Outcomes and Costs Following Partial Nephrectomy in England: A Population-based Study

BackgroundThe benefits of minimally invasive partial nephrectomy (PN) for localised renal cancers are well established. Outcomes and hospital activity following PN have not been studied for the English National Health System, despite a growing use of robotic-assisted PN (RAPN). ObjectiveTo compare 90-d complication rates and 1-yr hospital activity and costs following PN using routinely-collected national data. Design, setting, and participantsWe analysed Hospital Episode Statistics data for 4275 patients undergoing open PN (OPN), laparoscopic PN, or RAPN between October 2008 and September 2014. Outcome measurements and statistical analysisHospital activity and costs estimated using multivariate Generalised Linear Models. Logistic regression was used to model postoperative complications. Results and limitationsCompared with RAPN, OPN experienced more frequent 90-d readmissions for wound-related complications (n=68 vs n=3, p=0.014) and postoperative infections (n=151 vs n=11, p=0.045). One-year inpatient admissions were higher in OPN (incidence rate: 1.628 vs 0.928, p=0.004). Outcomes in laparoscopic PN and RAPN were equivalent. In comparison to OPN, RAPN was associated with lower complication-related costs at 90 d (mean £317.21 vs £129.29, p=0.002) and total costs at 1 yr (mean £2998.55 vs £2089.37, p=0.024). Limitations were the absence of clinical indicators for risk adjustment. ConclusionsHospital activity is significantly lower in the year immediately following RAPN compared with OPN. This is driven in part by a reduction in postoperative complications requiring readmission, reflecting lower total costs. Patient summaryWe analysed national data for 4275 patients undergoing partial nephrectomy via open, laparoscopic, or robotic assisted laparoscopic surgery in England over a 6-yr period. Robotic assisted laparoscopic surgery was associated with fewer 90-d complications and lower total costs at 1-yr postintervention.

Viral hepatitis and Parkinson disease: A national record-linkage study.

To study associations between viral hepatitis and Parkinson disease (PD). A retrospective cohort study was done by analyzing linked English National Hospital Episode Statistics and mortality data (1999-2011). Cohorts of individuals with hepatitis B, hepatitis C, autoimmune hepatitis, chronic active hepatitis, and HIV were constructed, and compared to a reference cohort for subsequent rates of PD. The standardized rate ratio (RR) of PD following hepatitis B was 1.76 (95% confidence interval [CI] 1.28-2.37) (p < 0.001), based on 44 observed compared with 25 expected cases. The RR of PD following hepatitis C was 1.51 (95% CI, 1.18-1.9) (p < 0.001), based on 48.5 expected and 73 observed cases. There was no significant association between autoimmune hepatitis, chronic active hepatitis or HIV, and subsequent PD. When including only those episodes of care for PD that occurred first at least 1 year following each exposure condition, the RR for hepatitis B and hepatitis C were 1.82 (1.29-2.5) and 1.43 (1.09-1.84), respectively. We report strong evidence in favor of an elevation of rates of subsequent PD in patients with hepatitis B and hepatitis C. These findings may be explained by factors peculiar to viral hepatitis, but whether it reflects consequences of infection, shared disease mechanisms, or the result of antiviral treatment remains to be elucidated. Further work is needed to confirm this association and to investigate pathophysiologic pathways, potentially advancing etiologic understanding of PD more broadly.

Risk of Cerebrovascular Events in 178 962 Five-Year Survivors of Cancer Diagnosed at 15 to 39 Years of Age: The TYACSS (Teenage and Young Adult Cancer Survivor Study).

Survivors of teenage and young adult cancer are at risk of cerebrovascular events, but the magnitude of and extent to which this risk varies by cancer type, decade of diagnosis, age at diagnosis, and attained age remains uncertain. This is the largest-ever cohort study to evaluate the risks of hospitalization for a cerebrovascular event among long-term survivors of teenage and young adult cancer. The population-based TYACSS (Teenage and Young Adult Cancer Survivor Study) (N=178,962) was linked to Hospital Episode Statistics data for England to investigate the risks of hospitalization for a cerebrovascular event among 5-year survivors of cancer diagnosed when 15 to 39 years of age. Observed numbers of first hospitalizations for cerebrovascular events were compared with that expected from the general population using standardized hospitalization ratios (SHRs) and absolute excess risks per 10 000 person-years. Cumulative incidence was calculated with death considered a competing risk. Overall, 2782 cancer survivors were hospitalized for a cerebrovascular event-40% higher than expected (SHR=1.4, 95% confidence interval, 1.3-1.4). Survivors of central nervous system (CNS) tumors (SHR=4.6, 95% confidence interval, 4.3-5.0), head and neck tumors (SHR=2.6, 95% confidence interval, 2.2-3.1), and leukemia (SHR=2.5, 95% confidence interval, 1.9-3.1) were at greatest risk. Males had significantly higher absolute excess risks than females (absolute excess risks =7 versus 3), especially among head and neck tumor survivors (absolute excess risks =30 versus 11). By 60 years of age, 9%, 6%, and 5% of CNS tumor, head and neck tumor, and leukemia survivors, respectively, had been hospitalized for a cerebrovascular event. Beyond 60 years of age, every year, 0.4% of CNS tumor survivors were hospitalized for a cerebral infarction (versus 0.1% expected), whereas at any age, every year, 0.2% of head and neck tumor survivors were hospitalized for a cerebral infarction (versus 0.06% expected). Survivors of a CNS tumor, head and neck tumor, and leukemia are particularly at risk of hospitalization for a cerebrovascular event. The excess risk of cerebral infarction among CNS tumor survivors increases with attained age. For head and neck tumor survivors, this excess risk remains high across all ages. These groups of survivors, particularly males, should be considered for surveillance of cerebrovascular risk factors and potential pharmacological interventions for cerebral infarction prevention.

High burden of hospital resource utilization in patients with hidradenitis suppurativa in England: a retrospective cohort study using hospital episode statistics.

The health resource utilization associated with managing patients with hidradenitis suppurativa (HS) in England is unknown. To describe the characteristics of patients with HS and hospital resource use associated with management of HS in England. A retrospective cohort study using Hospital Episode Statistics data. Patients with a primary diagnostic code for HS (ICD-10 code L73·2) during an inpatient admission (n = 11 359) between 1 April 2007 and 31 December 2013 were identified; patients with code L73·2 attending only as outpatients were excluded. Data for all inpatient, outpatient and accident and emergency admissions during the study period were extracted. Of the 11 359 patients, 10 832 had a first recorded inpatient HS diagnostic code (index spell) during the study period (female 7569, 69·9%). The mean age at the index spell was 39 ± 13·1 years in men and 36 ± 11·7 years in women. There were 65 544 inpatient spells during the study period; 7202 (63·4%) patients underwent nonelective spells, 4128 (36.3%) elective spells and 9790 (86·2%) day-case attendances. There were 43 773 accident and emergency attendances during the study period in 8716 (76·7%) patients. There were 303 204 outpatient appointments in 11 203 patients (mean 27·1 per patient); 4827 (42·5%) of the study population attended dermatology, 8087 (71·2%) general surgery and 4111 (36·2%) plastic surgery. Based on the mean number of spells per patient per year, the mean hospital resource utilization cost for a patient with HS was £2027 per patient per year. HS is associated with a large burden of hospital attendances for young patients of working age and high National Health Service resource costs.

Impact of hepatobiliary service centralization on treatment and outcomes in patients with colorectal cancer and liver metastases.

BackgroundCentralization of specialist surgical services can improve patient outcomes. The aim of this cohort study was to compare liver resection rates and survival in patients with primary colorectal cancer and synchronous metastases limited to the liver diagnosed at hepatobiliary surgical units (hubs) with those diagnosed at hospital Trusts without hepatobiliary services (spokes).MethodsThe study included patients from the National Bowel Cancer Audit diagnosed with primary colorectal cancer between 1 April 2010 and 31 March 2014 who underwent colorectal cancer resection in the English National Health Service. Patients were linked to Hospital Episode Statistics data to identify those with liver metastases and those who underwent liver resection. Multivariable random‐effects logistic regression was used to estimate the odds ratio of liver resection by presence of specialist hepatobiliary services on site. Survival curves were estimated using the Kaplan–Meier method.ResultsOf 4547 patients, 1956 (43·0 per cent) underwent liver resection. The 1081 patients diagnosed at hubs were more likely to undergo liver resection (adjusted odds ratio 1·52, 95 per cent c.i. 1·20 to 1·91). Patients diagnosed at hubs had better median survival (30·6 months compared with 25·3 months for spokes; adjusted hazard ratio 0·83, 0·75 to 0·91). There was no difference in survival between hubs and spokes when the analysis was restricted to patients who had liver resection (P = 0·620) or those who did not undergo liver resection (P = 0·749).ConclusionPatients with colorectal cancer and synchronous metastases limited to the liver who are diagnosed at hospital Trusts with a hepatobiliary team on site are more likely to undergo liver resection and have better survival.

Hypospadias surgery in England: Higher volume centres have lower complication rates

Hypospadias surgery has progressed steadily over recent years. There remains considerable variation in the operative management of boys with hypospadias in the UK, and it is therefore difficult to identify acceptable standards with regards to reoperation rates. To determine the frequency of reoperations and complications from all centres performing hypospadias surgery in England and to identify variables that influence outcome. All children undergoing NHS hypospadias surgery in England between 1999 and 2009 were identified using the Hospital Episode Statistics database. Patient demographics, centre type, and associated diagnostic (ICD-10) and treatment codes (OPCS4.6) were collected for both primary repairs and postoperative complications. Centres were classed as high volume if they performed an average of 20 or more operations a year. Operative complications were split into revisions (repeat repairs), repairs of urethral fistulae, repairs of meatal stenosis, or urethral stricture repairs. Statistical analysis included logistic regression, Spearman's correlation, and Mann-Whitney U for non-parametric data, with p<0.05 taken as significant. Data are presented as median (interquartile range) unless otherwise stated. children underwent a total of 23,962 operations at 75 centres in England during the study period. The median age at primary repair was 21 (15-38) months. The overall complication rate was 18.1%. The median complication rate for individual centres was 20.0% (13.9-27.4%) overall; 10.8% (4.7-15.9%) for revision procedures, 8.1% (5.5-11.7%) for urethral fistulae, 2.3% (1.1-3.7%) for meatal stenosis repairs, and 1.8% (0-2.8%) for urethral strictures. High volume centres had significantly lower complication rates than low volume centres (17.5% vs. 25%, p=0.01) (Figure), and this was proven to be an independent predictor of outcomes (p=0.01). Staged repairs were associated with more complications (p<0.001); however, patient age and centre type were not. Median time to repair of complication was 13 (8-22) months. This national population-based study used hospital episode statistics data. While accuracy is high and it has been validated for use in research, it has intrinsic limitations which affect our study. We are unable to fully account for the severity of hypospadias or the number of operating surgeons within institutions. This study has found a clear relationship between caseload volume and complications following hypospadias surgery. Furthermore, there is significant variability between centres in terms of their surgical outcomes. Taken together these results suggest that surgeons, particularly those in centres with small caseloads should assess their results against such benchmarks when evaluating the service they provide.

An evaluation of the costs and consequences of Children Community Nursing teams

Recent years have seen an increasing shift towards providing care in the community, epitomised by the role of Children's Community Nursing (CCN) teams. However, there have been few attempts to use robust evaluative methods to interrogate the impact of such services. This study sought to evaluate whether reduction in secondary care costs, resulting from the introduction of 2 CCN teams, was sufficient to offset the additional cost of commissioning. Among the potential benefits of the CCN teams is a reduction in the burden placed on secondary care through the delivery of care at home; it is this potential reduction which is evaluated in this study via a 2-part analytical method. Firstly, an interrupted time series analysis used Hospital Episode Statistics data to interrogate any change in total paediatric bed days as a result of the introduction of 2 teams. Secondly, a costing analysis compared the cost savings from any reduction in total bed days with the cost of commissioning the teams. This study used a retrospective longitudinal study design as part of the transforming children's community services trial, which was conducted between June 2012 and June 2015. A reduction in hospital activity after introduction of the 2 nursing teams was found, (9634 and 8969 fewer bed days), but this did not reach statistical significance. The resultant cost saving to the National Health Service was less than the cost of employing the teams. The study represents an important first step in understanding the role of such teams as a means of providing a high quality of paediatric care in an era of limited resource. While the cost saving from released paediatric bed days was not sufficient to demonstrate cost-effectiveness, the analysis does not incorporate wider measures of health care utilisation and nonmonetary benefits resulting from the CCN teams.

Use of routinely collected Hospital Episode Statistics to describe alcohol-related frequent attenders to hospitals

BackgroundExcess alcohol consumption is a growing public health problem, causing 5·3% of deaths worldwide in those aged under 60 years. In the UK, alcohol use costs the National Health Service (NHS) £3·5 billion annually, 80% of which is used for hospital-based care. Alcohol-related hospital admissions have doubled in the past 8 years in England. With no universal way of identifying hospital admissions of alcohol-related frequent attenders (ARFAs), the true burden on the NHS is unknown including use of accident and emergency services, costs of inpatient admissions, and long-term health and social care. We aimed to identify characteristics of ARFAs to investigate whether they differ from other hospital service users and to better understand the complexity of this group. MethodsUsing pseudonymised Hospital Episode Statistics data from the Secondary Uses Service, ARFAs (more than three admissions per year, including at least one wholly attributable alcohol diagnosis in any diagnostic field) were identified from all admissions to south London hospitals between April 1, 2013, and March 31, 2014. Comorbidities, age, sex, and income deprivation for ARFAs were compared with those of all other admitted patients. Findings1897 ARFAs were identified from a total of 366 616 people admitted (5198 [0·7%] of 740 818 admissions). ARFAs were more likely than other admitted patients to be male (72·4% [1373/1897] vs 37·9% [124 919/329 218], p<0·0001), to be income deprived (Index of Multiple Deprivation 04 score 28·04, p<0·0001), and to have comorbidities (22% [417/1897] vs 8% [28 737/364 719]). ARFAs were also more likely to be older than other attenders (mean age ARFAs 55·4 years [SD 15·1] vs alcohol-related non-frequent attenders 50·0 [16·2], p<0·0001, and non-alcohol-related non-frequent attenders 51·6 [20·3], p<0·0001) but younger than non-alcohol-related frequent attenders (55·4 [15·1] vs 56·9 [21·1], p=0·01). Relative risk of comorbidity for ARFAs versus all other patients was 9·35 for self-harm (p<0·0001), 3·29 for assault (p<0·0001), 2·04 for diabetes mellitus (p<0·0001), 1·73 for circulatory disease (p<0·0001), 1·58 for cancer attributable to alcohol (p=0·0292), and 1·45 for mental health (p<0·0001). InterpretationARFAs have distinct characteristics that differentiate them from other patient groups: preliminary analysis shows that ARFAs tend to be older, male, experiencing income deprivation, and more likely to have comorbidities. An understanding of the characteristics of ARFAs and their health service use might help target preventive interventions to this group, reducing harms before high costs for the NHS are accrued. FundingInnovation fellowship supported by the Health Innovation Network (Academic Health Science Network for South London). This research is partly funded by the National Institute for Health Research Collaboration for Leadership in Applied Health Research.

Recurrence risk of venous thromboembolism and hormone use in women from England: a cohort study using clinical practice research datalink.

It is vital to identify people with low recurrence risk of venous thromboembolism (VTE) so as to protect them from dangers of prolonged anticoagulation therapy. Among women who develop VTE following hormone use, the evidence as to whether their risk of recurrence is low if they cease this therapy is conflicting. We investigated whether women whose initial VTE event was hormone-related have a lower risk of VTE recurrence than women whose initial event had no obvious cause (unprovoked). A cohort study utilising the Clinical Practice Research Datalink linked to Hospital Episode Statistics data from England was conducted. We selected 4170 women aged between 15 and 64years who were diagnosed with a first VTE event between 1997 and 2011. Cox regression models were used to obtain hazard ratios (HR). Hormone users had 29% lower recurrence risk than non-users (adjusted HR=0·71; 95% confidence interval 0·58-0·88), a relationship which existed both in women aged 15-44years (predominantly oral contraceptive users) and those aged 45-64years (predominantly hormone replacement therapy users). In conclusion, having a hormone-associated VTE is associated with a lower recurrence risk than one that is unprovoked after discontinuation of the hormone-containing preparation. Prolonged anticoagulation may therefore be unjustified in such women.

Trends in incidence, mortality and treatment of penile cancer before and after centralisation of penile cancer services in England (1990–2009)

Objective: Penile cancer services were centralised in England in 2002. Has this had an impact on treatments for penile cancer and survival? Patients and methods: All cases of penile cancer from 1990 to 2009 were identified from national cancer registry data. Mortality data were obtained from the Office for National Statistics and survival data were extracted from a national population-based database, the Cancer Information System. Socioeconomic deprivation was calculated using a national income deprivation score and surgical treatments were obtained from Hospital Episode Statistics (HES) data. Results: The number of penile cancer cases recorded rose from 300 to 400 per year during the early period of centralisation. There was a significant rise in the age-standardised incidence of penile cancer from 1.2 per 100,000 to 1.4 per 100,000 during this period. Mortality remained stable at 0.3 per 100,000. One-year and five-year relative survival remained stable after centralisation at 88% and 72% respectively. The incidence and mortality of penile cancer was significantly higher in the most deprived quintile of the population. Following centralisation, the number of total penile amputations was low at 11% but only 39% of men were recorded as having lymph node surgery, although this may reflect poor compliance with coding rather than true practice. Conclusions: The incidence of penile cancer in England is rising, but mortality and survival remains stable. Incidence and mortality is higher in more deprived areas, and greater public awareness of this disease and its risk factors are needed. By 2009, rates of penile amputation were low but potentially the proportion of lymph-node surgery remained low. This may change with the uptake of inguinal sentinel lymph-node sampling.

P3.07-011 Geographical Variation in the Use of Radiotherapy and Surgical Resection for Treatment of Non-Small Cell Lung Cancer in England: Topic: Other – Geographical Differences

Despite global improvements in survival non-small cell lung cancer (NSCLC) remains lethal, with 20% five year survival in a limited number of developed nations. Fit, early stage NSCLC patients can be offered curative treatment, using surgery or radical radiotherapy. Geographical variation in surgery usage in England has previously been demonstrated. We aimed to further investigate this variation, incorporating all curative treatments and considering associated survival. Information on 143,886 patients diagnosed with a first NSCLC between April 2009 and December 2013 in England was extracted from the national cancer registration dataset linked to radiotherapy treatment and Hospital Episode Statistics data. In England Clinical Commissioning Groups (CCG) are the statutory bodies responsible for the planning and commissioning of health care services for their local area. We calculated the proportion of patients receiving curative treatment in each CCG, and created quintiles from the resulting distribution. Logistic regression was used to assess the effect of age, sex, stage, comorbidity, performance status and socio-economic deprivation on curative treatment usage. Multivariable Cox regression models were used to analyze survival in relation to curative treatment quintile. Overall, 29,580 (20.6%) NSCLC patients received curative treatment: 20,177 (14.0%) NSCLC patients underwent resection and 9,403 (6.5%) received radical radiotherapy. The proportion of patients receiving curative treatments ranged from 11.8% to 31.7% across English CCGs and decreased with advancing age (p < 0.001), increasing stage (p < 0.001) and worsening performance status (p < 0.001). The proportion of patients receiving curative treatment was greater for females compared with males (p < 0.001). The absolute risk of dying within 5 years ranged from 90% in the lowest treatment quintile to 85% in the highest. Increasing curative treatment rates were associated with lower mortality (p < 0.001), with an adjusted HR of 0.93 (95% CI 0.92 to 0.95) in the highest treatment quintile compared with the lowest. Despite adjustment for case-mix variables we demonstrated that significant variation in the use of curative treatment for NSCLC persists across CCGs with increasing curative treatment rates associated with lower mortality. There is a need to further explore the factors driving this variation in order to guide changes in care which may deliver improved outcomes.

Using geographic variation in unplanned ambulatory care sensitive condition admission rates to identify commissioning priorities: an analysis of routine data from England.

Objectives To use geographic variation in unplanned ambulatory care sensitive condition admission rates to identify the clinical areas and patient subgroups where there is greatest potential to prevent admissions and improve the quality and efficiency of care. Methods We used English Hospital Episode Statistics data from 2011/2012 to describe the characteristics of patients admitted for ambulatory care sensitive condition care and estimated geographic variation in unplanned admission rates. We contrasted geographic variation across admissions with different lengths of stay which we used as a proxy for clinical severity. We estimated the number of bed days that could be saved under several scenarios. Results There were 1.8 million ambulatory care sensitive condition admissions during 2011/2012. Substantial geographic variation in ambulatory care sensitive condition admission rates was commonplace but mental health care and short-stay (<2 days) admissions were particularly variable. Reducing rates in the highest use areas could lead to savings of between 0.4 and 2.8 million bed days annually. Conclusions Widespread geographic variations in admission rates for conditions where admission is potentially avoidable should concern commissioners and could be symptomatic of inefficient care. Further work to explore the causes of these differences is required and should focus on mental health and short-stay admissions.

Validation of Stevens-Johnson syndrome or toxic epidermal necrolysis diagnoses in the Clinical Practice Research Datalink.

To evaluate the validity of recorded diagnoses of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) in the Clinical Practice Research Datalink (CPRD). We identified patients with a diagnosis of SJS or TEN between 1995 and 2013 in the CPRD. We reviewed information from patient records, free text, and hospital episode statistics (HES) data, and excluded patients with no indication of a secondary care referral. Remaining patients were classified as probable, possible, or unlikely cases of SJS/TEN by two specialised clinicians or based on pre-defined classification criteria. We quantified positive predictive values (PPV) for all SJS/TEN patients and for patients categorised as 'probable/possible' cases of SJS/TEN, based on a representative subsample of 118 patients for whom we had unequivocal information (original discharge letters or HES data). We identified 1324 patients with a diagnosis of SJS/TEN, among whom 638 had a secondary care referral recorded. Of those, 565 were classified as probable or possible cases after expert review. We calculated a PPV of 0.79 (95% CI, 0.71-0.86) for all SJS/TEN patients with a recorded secondary care referral, and a PPV of 0.87 (95% CI, 0.81-0.93) for probable/possible cases. After excluding 14 false positive patients, our study population consisted of 551 SJS/TEN patients. Diagnoses of SJS/TEN are recorded with moderate diagnostic accuracy in the CPRD, which was substantially improved by additional expert review of all available information. We established a large population-based SJS/TEN study population of high diagnostic validity from the CPRD. Copyright © 2016 John Wiley & Sons, Ltd.

Recording of hospitalizations for acute exacerbations of COPD in UK electronic health care records.

BackgroundAccurate identification of hospitalizations for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) within electronic health care records is important for research, public health, and to inform health care utilization and service provision. We aimed to develop a strategy to identify hospitalizations for AECOPD in secondary care data and to investigate the validity of strategies to identify hospitalizations for AECOPD in primary care data.MethodsWe identified patients with chronic obstructive pulmonary disease (COPD) in the Clinical Practice Research Datalink (CPRD) with linked Hospital Episodes Statistics (HES) data. We used discharge summaries for recent hospitalizations for AECOPD to develop a strategy to identify the recording of hospitalizations for AECOPD in HES. We then used the HES strategy as a reference standard to investigate the positive predictive value (PPV) and sensitivity of strategies for identifying AECOPD using general practice CPRD data. We tested two strategies: 1) codes for hospitalization for AECOPD and 2) a code for AECOPD other than hospitalization on the same day as a code for hospitalization due to unspecified reason.ResultsIn total, 27,182 patients with COPD were included. Our strategy to identify hospitalizations for AECOPD in HES had a sensitivity of 87.5%. When compared with HES, using a code suggesting hospitalization for AECOPD in CPRD resulted in a PPV of 50.2% (95% confidence interval [CI] 48.5%–51.8%) and a sensitivity of 4.1% (95% CI 3.9%–4.3%). Using a code for AECOPD and a code for hospitalization due to unspecified reason resulted in a PPV of 43.3% (95% CI 42.3%–44.2%) and a sensitivity of 5.4% (95% CI 5.1%–5.7%).ConclusionHospitalization for AECOPD can be identified with high sensitivity in the HES database. The PPV and sensitivity of strategies to identify hospitalizations for AECOPD in primary care data alone are very poor. Primary care data alone should not be used to identify hospitalizations for AECOPD. Instead, researchers should use data that are linked to data from secondary care.

Alcohol misuse and injury outcomes in young people: a cohort analysis of linked primary and secondary data in England

BackgroundThe burden of disease attributed to alcohol consumption is a global problem. Alcohol misuse is thought to be a risk factor for injury in young people, though few studies have described this association in detail. This study aimed to assess the risk of hospital admission for injury in young people with a history of alcohol misuse. MethodsWe conducted a cohort study of young people aged 10–24 years registered at a Clinical Practice Research Datalink general practice between Jan 1, 1998, and Dec 31, 2013, with linked Hospital Episode Statistics data. Exposed individuals had an alcohol-specific admission to hospital between the ages of 10 and 24 years, as defined by the International Classification of Diseases, 10th revision. Unexposed individuals had no alcohol-specific admission, and were frequency matched by age (plus or minus 5 years) and general practice (ratio 10 to 1). The incidence rate (events per person-year) of first injury-related admission to hospital was calculated and the mechanisms described. Hazard ratios (HR) adjusted for age, sex, deprivation, and region were estimated by Cox regression, with an interaction term included between exposure and time. FindingsThe cohort comprised 11 042 exposed and 110 656 unexposed individuals. Exposed individuals had longer median follow-up time than unexposed individuals (2·17 years [IQR 0·82–4·44] vs 1·20 [0·38–3·09]), and were more likely to be from the most deprived socioeconomic quintile (3274 [29·7%] exposed vs 26 990 [24·3%] unexposed) and be male (56·8% exposed vs 47·3% unexposed). 4944 injury-related admissions occurred (2092 exposed, 2852 unexposed), with injury rates higher in those with than in those without a previous alcohol admission (73·92 per 1000 person-years, 95% CI 70·82–77·16 vs 12·36, 11·91–12·81). Individuals with a previous alcohol-specific admission were 5·28 times more likely to have an injury admission than those without at 1 year (HR 5·28, 95% CI 4·97–5·60), with the interaction term (0·65, 95% CI 0·62–0·67) indicating that injury risk significantly depreciated after alcohol admission. The most common injury mechanism was poisoning in exposed individuals and falls in unexposed individuals. InterpretationThis is the largest study, to our knowledge, demonstrating that alcohol-specific admissions to hospital are associated with subsequent admission for injury in young people, with risk of injury greatest after the alcohol admission and reducing over time. This finding indicates a need for early intervention during admissions and after discharge, providing information and referral (eg, specialist alcohol or mental health services), and developing effective interventions to reduce subsequent risk of injury. FundingNational Institute for Health Research (NIHR) School for Primary Care Research.