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Distance travelled to hospital for emergency laparotomy and the effect of travel time on mortality: cohort study
  1. Tom Salih1,2,
  2. Peter Martin3,
  3. Tom Poulton4,
  4. Charles M Oliver1,2,
  5. Mike G Bassett5,
  6. S Ramani Moonesinghe2,4
  7. NELA Project Team
    1. 1Department of Anaesthesia, University College London Hospitals NHS Foundation Trust, London, UK
    2. 2Division of Surgery and Interventional Science, Department for Targeted Intervention, Surgical Outcomes Research Centre, Centre for Perioperative Medicine, University College London, London, UK
    3. 3Department of Applied Heath Research, University College London, London, UK
    4. 4Health Services Research Centre, National Institute for Academic Anaesthesia, London, UK
    5. 5Department of Anaesthesia, Manchester University NHS Foundation Trust, Manchester, UK
    1. Correspondence to Dr Tom Salih, Department of Anaesthesia, University College London Hospitals NHS Foundation Trust, London NW1 2BU, UK; tomsalih{at}doctors.net.uk

    Abstract

    Objectives To evaluate whether distance and estimated travel time to hospital for patients undergoing emergency laparotomy is associated with postoperative mortality.

    Design National cohort study using data from the National Emergency Laparotomy Audit.

    Setting 171 National Health Service hospitals in England and Wales.

    Participants 22 772 adult patients undergoing emergency surgery on the gastrointestinal tract between 2013 and 2016.

    Main outcome measures Mortality from any cause and in any place at 30 and 90 days after surgery.

    Results Median on-road distance between home and hospital was 8.4 km (IQR 4.7–16.7 km) with a median estimated travel time of 16 min. Median time from hospital admission to operating theatre was 12.7 hours. Older patients live on average further from hospital and patients from areas of increased socioeconomic deprivation live on average less far away.

    We included estimated travel time as a continuous variable in multilevel logistic regression models adjusting for important confounders and found no evidence for an association with 30-day mortality (OR per 10 min of travel time=1.02, 95% CI 0.97 to 1.06, p=0.512) or 90-day mortality (OR 1.02, 95 % CI 0.97 to 1.06, p=0.472).

    The results were similar when we limited our analysis to the subgroup of 5386 patients undergoing the most urgent surgery. 30-day mortality: OR=1.02 (95% CI 0.95 to 1.10, p=0.574) and 90-day mortality: OR=1.01 (95% CI 0.94 to 1.08, p=0.858).

    Conclusions In the UK NHS, estimated travel time between home and hospital was not a primary determinant of short-term mortality following emergency gastrointestinal surgery.

    • health policy
    • health services research
    • hospital medicine
    • surgery
    http://creativecommons.org/licenses/by-nc/4.0/

    This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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    Footnotes

    • Twitter @CMOliver_, @RMOONESINGHE

    • Collaborators Members of the NELA Project Team during the data collection period of this study were: Mr Iain Anderson, Dr Mike Bassett, Mr Martin Cripps, Mr Paul Cripps, Professor David Cromwell, Mrs Emma Davies, Ms Sharon Drake, Ms Natalie Eugene, Mr James Goodwin, Professor Mike Grocott, Dr Sarah Hare, Dr Carolyn Johnston, Dr Angela Kuryba, Ms Sonia Lockwood, Mr Jose Lourtie, Professor S Ramani Moonesinghe, Dr Dave Murray, Dr Charles M Oliver, Mr Dimitri Papadimitriou, Dr Carol Peden, Dr Tom Poulton, Dr Tom Salih, Dr Kate Walker and Ms Susan Warren.

    • Contributors Conceptualisation: TS, SRM. Data curation: TS, TP, CMO, MGB. Methodology: TS, PM, SRM. Investigation: all authors. Formal analysis: TS, PM. Software: TS. Project administration: TS, SRM. Study supervision: PM, SRM. Validation: all authors. Visualisation: TS. Writing original draft: TS. Review/editing of manuscript: all authors. Local NELA leads and contributors to NELA data across England and Wales.

    • Funding The National Emergency Laparotomy Audit is commissioned by the Healthcare Quality Improvement Partnership as part of the National Clinical Audit Programme on behalf of NHS England and the Welsh government.

    • Map disclaimer The depiction of boundaries on this map does not imply the expression of any opinion whatsoever on the part of BMJ (or any member of its group) concerning the legal status of any country, territory, jurisdiction or area or of its authorities. This map is provided without any warranty of any kind, either express or implied.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval NELA is approved by the Health Research Authority’'s Confidentiality Advisory Group for ‘Use of Patient Identifiable Information without Consent’' (Section 251 of NHS Act 2006 and Health Service (Control of Patient Information) Regulations 2002). This study received approval from the Healthcare Quality Improvement Partnership. Patient data are stored on a secure server and access is controlled in accordance with Caldicott principles.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data may be obtained from a third party and are not publicly available. NELA’s funder and the data controller for NELA data is the Healthcare Quality Improvement Partnership. For access to NELA data see: www.nela.org.uk/NELA_Research.

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