Does the introduction of HDU reduce surgical mortality?
The aim of this study was to assess the change in workload in a general surgery department over 2 consecutive 1-year periods and document the impact of a high dependency unit (HDU) on hospital mortality. Data were collected on all admissions, the number and type of operations performed for a 1-year period before and after a purpose-built HDU was opened. During the study period, the total number of admissions increased by 15%, with a disproportionately large increase (27%) in the number of emergency admissions. This was reflected by increases in the emergency out-of-hours operating by 12%. During the study period, the overall in-patient mortality rose from 2.16% to 3.2%. Introduction of HDU facilities alone does not lead to a reduction in hospital mortality. Alterations in emergency workload and changes in case-mix are important in determining outcome. League tables of hospital mortality are likely to be difficult to interpret without adequate information about facilities and case-mix.
Davies
J
J
Department of Surgery, Pinderfields Hospital, Wakefield, UK.
Tamhane
R
R
Scholefield
C
C
Curley
P
P
D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures / Q000706:statistics & numerical data; D003953:Diagnosis-Related Groups; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data; D004630:Emergencies / Q000453:epidemiology; D004739:England / Q000453:epidemiology; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D013514:Surgical Procedures, Operative / Q000401:mortality*; D016526:Workload