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. 2020 Jun 23;30(5):397-406.
doi: 10.1136/bmjqs-2019-010747. Online ahead of print.

Distance travelled to hospital for emergency laparotomy and the effect of travel time on mortality: cohort study

Tom Salih  1   2 , Peter Martin  3 , Tom Poulton  4 , Charles M Oliver  5   2 , Mike G Bassett  6 , S Ramani Moonesinghe  2   4 ; NELA Project Team
Collaborators, Affiliations

Distance travelled to hospital for emergency laparotomy and the effect of travel time on mortality: cohort study

Tom Salih et al. BMJ Qual Saf. .

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.

Keywords: health policy; health services research; hospital medicine; surgery.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Map of the study area showing 171 hospitals in England and Wales that accept patients for emergency laparotomy. Background map image: Stamen maps. Includes Office for National Statistics data containing public sector information licensed under the Open Government License v3.0. LSOA, lower layer super output area.
Figure 2
Figure 2
STROBE flow diagram. NELA, National Emergency Laparotomy Audit.
See this image and copyright information in PMC

References

    1. National Emergency Laparotomy Audit (NELA) Project Team . First patient report of the National emergency laparotomy audit. London, 2014. Available: www.nela.org.uk/reports
    1. National Emergency Laparotomy Audit (NELA) Project Team . Second patient report of the National emergency laparotomy audit. London, 2016. Available: www.nela.org.uk/reports
    1. National Emergency Laparotomy Audit (NELA) Project Team . Third patient report of the National emergency laparotomy audit. London, 2017. Available: www.nela.org.uk/reports
    1. National Emergency Laparotomy Audit (NELA) Project Team . Fourth patient report of the National emergency laparotomy audit. London, 2018. Available: www.nela.org.uk/reports
    1. Oliver CM, Bassett MG, Poulton TE, et al. Organisational factors and mortality after an emergency laparotomy: multilevel analysis of 39 903 national emergency laparotomy audit patients. Br J Anaesth 2018;121:1346–56. 10.1016/j.bja.2018.07.040 - DOI - PubMed