title: Inter-relationship of procedural mortality rates in vascular surgery in England: retrospective analysis of hospital episode statistics from 2005 to 2010.
abstract: BACKGROUND
  Wide variations in vascular surgical outcomes have been demonstrated in England. The objective of this study was to determine whether risk-adjusted postoperative mortality rates for elective and emergency vascular surgical procedures were inter-related.
  
  
  RESULTS
  A retrospective observational study using National Health Service administrative data on adult patients undergoing elective or emergency vascular surgery from 2005 to 2010. The 10 procedures covered the broad spectrum of workload for a vascular surgical service. The primary outcome measure was in-hospital mortality, and secondary outcomes were 30-day and 1-year mortality. Data were risk-adjusted using multilevel modeling. Analyses comprised a 2-level basket designed to evaluate variations in outcome and whether the outcome of each procedure could be predicted by the composite outcome of all other procedures. A total of 116,596 vascular surgical procedures were performed across 166 providers. For 9 of 10 procedures, there were hospitals lying outside 95% control limits for ≥1 mortality outcome. The key finding was that ≥1 risk-adjusted mortality outcome for any 1 of the 9 vascular surgical procedures could be predicted by the aggregated within provider performance of the other vascular surgical procedures combined.
  
  
  CONCLUSIONS
  Hospital-level risk-adjusted mortality for both elective and emergency vascular procedures in England varies considerably, and providers were globally high or low performers. The data should be made available to patients, relatives, and the purchasers of services to drive improvements in the provision of vascular surgical services.
authors.affiliation: Department of Outcomes Research, St George's University of London, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Sinha
authors.forename: A
authors.initials: A
authors.lastname: Karthikesalingam
authors.forename: J D
authors.initials: JD
authors.lastname: Poloniecki
authors.forename: M M
authors.initials: MM
authors.lastname: Thompson
authors.forename: P J
authors.initials: PJ
authors.lastname: Holt
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000453:epidemiology* / Q000601:surgery*; D017558:Elective Surgical Procedures / Q000401:mortality*; D004638:Emergency Treatment / Q000401:mortality*; D016894:Endarterectomy, Carotid / Q000401:mortality; D004739:England / Q000453:epidemiology; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D012307:Risk Factors; D013222:State Medicine / Q000706:statistics & numerical data*; D015996:Survival Rate; D014656:Vascular Surgical Procedures / Q000401:mortality*
keywords: aneurysm; benchmarking; health services research; mortality; outcome assessment (health care); quality of healthcare