title: Variation in reoperation after colorectal surgery in England as an indicator of surgical performance: retrospective analysis of Hospital Episode Statistics.
abstract: OBJECTIVE
  To describe national reoperation rates after elective and emergency colorectal resection and to assess the feasibility of using reoperation as a quality indicator derived from routinely collected data in England.
  
  
  METHODS
  Retrospective observational study of Hospital Episode Statistics (HES) data.
  
  
  METHODS
  HES dataset, an administrative dataset covering the entire English National Health Service.
  
  
  METHODS
  All patients undergoing a primary colorectal resection in England between 2000 and 2008.
  
  
  METHODS
  Reoperation after colorectal resection, defined as any reoperation for an intra-abdominal procedure or wound complication within 28 days of surgery on the index or subsequent admission to hospital.
  
  
  RESULTS
  The national reoperation rate was 6.5% (15,986/246,469). A large degree of variation was identified among institutions and surgeons. Even among institutions and surgical teams with high caseloads, threefold and fivefold differences in reoperation rates were observed between the highest and lowest performing trusts and surgeons. Of the NHS trusts studied, 14.1% (22/156) had adjusted reoperation rates above the upper 99.8% control limit. Factors independently associated with higher risk of reoperation were diagnosis of inflammatory bowel disease (odds ratio 1.33 (95% CI 1.24 to 1.42), P<0.001), presence of multiple comorbidity (odds ratio 1.34 (1.29 to 1.39), P<0.001), social deprivation (1.14 (1.08 to 1.20) for most deprived, P<0.001), male sex (1.33 (1.29 to 1.38), P<0.001), rectal resection (1.63 (1.56 to 1.71), P<0.001), laparoscopic surgery (1.11 (1.03 to 1.20), P = 0.006), and emergency admission (1.21 (1.17 to 1.26), P<0.001).
  
  
  CONCLUSIONS
  There is large variation in reoperation after colorectal surgery between hospitals and surgeons in England. If data accuracy can be assured, reoperation may allow performance to be checked against national standards from current routinely collected data, alongside other indicators such as mortality.
authors.affiliation: Department of Surgery, Imperial College, St Mary's Hospital, London W21NY, UK.
authors.forename: Elaine M
authors.initials: EM
authors.lastname: Burns
authors.forename: Alex
authors.initials: A
authors.lastname: Bottle
authors.forename: Paul
authors.initials: P
authors.lastname: Aylin
authors.forename: Ara
authors.initials: A
authors.lastname: Darzi
authors.forename: R John
authors.initials: RJ
authors.lastname: Nicholls
authors.forename: Omar
authors.initials: O
authors.lastname: Faiz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003107:Colorectal Surgery / Q000401:mortality / Q000592:standards*; D017558:Elective Surgical Procedures; D004638:Emergency Treatment / Q000706:statistics & numerical data / Q000639:trends; D004739:England; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000639:trends; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care / Q000706:statistics & numerical data / Q000639:trends; D012086:Reoperation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D055815:Young Adult