E Cosford | PubMed Health

PubMed1997

Does hospital mortality rate reflect quality of care on a surgical unit?

All deaths occurring in 1 year in the surgical unit of a district general hospital were analysed to determine to what extent crude mortality rates reflect the quality of care. There were 166 deaths, 70% of patients were aged 75 years and older, and 87.3% were emergency admissions. Almost one-half (46.4%) of the deaths were inevitable. This high proportion of inevitable deaths means that crude hospital mortality rates are a poor indicator of the quality of surgical care. Factors such as the nature of the catchment area served, the proportion of emergency versus elective admissions, the numbers of complex operations performed and the availability of convalescent or hospice facilities are a greater influence on surgical mortality rates than variations in the standard of surgical care. The use of crude hospital mortality rates to compare the quality of care given by surgical units should be discontinued as it is unreliable and misleading.

Adult↗

PubMed1996

Day-case tonsillectomy--is it appropriate?

There is continued encouragement to increase the use of day surgery. Recent publications have suggested that day-case tonsillectomy is a safe procedure due to the low primary haemorrhage rates (0.14-3.5%). One of the suggested benefits of day surgery is that patients want it. They prefer to recover at home after an operation. With tonsillectomy, personal experience suggested that this was not the case. A review of 117 patients having tonsillectomy was undertaken. All patients stayed in for at least one post-operative night. No patients or parents thought that the post-operative stay was too long (80% 'just right', 20% 'too short') and only 7% would have been happy to go home on the day of operation. 'Safety' does not automatically make an operation suitable for day-case surgery. Pain, nausea, vomiting, drowsiness and anxiety about the operation and post-operative course were all reasons given for not wanting to go home on the day of surgery. The justification for the increased use of day surgery is that it increases efficiency by reducing costs per case while maintaining the quality of care. One aspect of quality of care is patient acceptability and before day-case tonsillectomy is acceptable to patients the factors responsible for the post-operative morbidity need to be addressed.

Adult↗