title: Regional variation in critical care provision and outcome after high-risk surgery.
abstract: OBJECTIVE
  Evidence of variation in mortality after surgery may indicate preventable postoperative death. We sought to determine if regional differences in outcome were present in surgical patients admitted to critical care in the UK.
  
  
  METHODS
  We extracted data on admission characteristics, case mix and outcome of all patients admitted to UK critical care units following surgery for the calendar year of 2009. We also used publicly held data on regional population, volume of surgery and bed provision. Multilevel regression analysis was used to adjust for the effects of case mix and regional critical care bed provision on acute hospital mortality.
  
  
  RESULTS
  A total of 16,147 patients admitted to critical care following surgery were included in this analysis. Median odds ratio (MOR) was used to describe regional-level variance in acute hospital mortality. Significant variation was identified (MOR 1.14; 95% CI 1.07, 1.28) and persisted following adjustment for case mix (MOR 1.10; 95% CI 1.04, 1.25) and regional critical care bed provision (MOR 1.09; 95% CI 1.04, 1.24). Critical care bed utilisation (surgical critical care admissions per 100,000 surgical procedures) seemed to better explain this observation (MOR 1.03; 95% CI 1.00, 29.26) and was associated with statistically significant reduction in mortality (OR 0.91; 95% CI 0.85, 0.97; p = 0.01).
  
  
  CONCLUSIONS
  Significant regional variation in hospital mortality for patients admitted to critical care following surgery was observed. Critical care bed utilisation seemed to better explain this observation and was associated with improved outcome.
authors.affiliation: University of Edinburgh, Edinburgh, UK. Michael.gillies@ed.ac.uk.|Department of Anaesthesia, Critical Care and Pain Medicine, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, UK. Michael.gillies@ed.ac.uk.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Gillies
authors.affiliation: Intensive Care National Audit and Research Centre, London, UK.
authors.forename: G Sarah
authors.initials: GS
authors.lastname: Power
authors.affiliation: Intensive Care National Audit and Research Centre, London, UK.
authors.forename: David A
authors.initials: DA
authors.lastname: Harrison
authors.affiliation: Intensive Care National Audit and Research Centre, London, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Fleming
authors.affiliation: University of Edinburgh, Edinburgh, UK.|Information Services Division, Scottish Intensive Care Society Audit Group, Edinburgh, UK.
authors.forename: Brian
authors.initials: B
authors.lastname: Cook
authors.affiliation: University of Edinburgh, Edinburgh, UK.
authors.forename: Timothy S
authors.initials: TS
authors.lastname: Walsh
authors.affiliation: Queen Mary's University of London, London, UK.
authors.forename: Rupert M
authors.initials: RM
authors.lastname: Pearse
authors.affiliation: Intensive Care National Audit and Research Centre, London, UK.
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: Rowan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care / Q000592:standards*; D005260:Female; D013502:General Surgery / Q000706:statistics & numerical data*; D005843:Geography / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data; D011182:Postoperative Care / Q000592:standards* / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000628:therapy*; D017410:Practice Guidelines as Topic; D015996:Survival Rate; D006113:United Kingdom
keywords: Critical care; Epidemiology; General surgery; Intensive care