Original ResearchThe effect of ethnicity on in-hospital mortality following emergency abdominal surgery: a national cohort study using Hospital Episode Statistics
Introduction
Ethnicity can be classified by referring to a community of people who share the same culture and/or by referring to an ancestral population which comprises their self-identity.1 Self-reported ethnicity captures both the shared experiences/culture of an individual and their self-identity. According to the 2011 Consensus in some areas of the United Kingdom, especially around London, over 70% of the population report their ethnicity as ‘non-white’.2 Even those who are considered ‘White’ are comprised of a heterogeneous group of residents from Poland, Greece, Romania, Bulgaria and other Eastern countries.
Ethnicity has complex effects on health and the delivery of health care.3, 4, 5 This is a major issue not only in the UK, but also in other countries such as mainland Europe and the United States, both formed of similarly diverse communities.6 Many challenges exist when treating patients from an ethnic background different to that of the health service provider. These can be patient-related including language barriers and cultural barriers e.g. omissions of sensitive elements in the history and adequate expose patients for examinations.7, 8 In addition, there are known provider-related biases linked to racial and ethnic prejudice.9 At a population level, the effects of these factors are difficult to quantify individually, but may have a cumulative effect in delaying diagnosis, treatment and outcomes.
Rapid diagnosis and treatment is essential in patients requiring urgent and emergency abdominal surgery.10, 11, 12 Inappropriate delays produce profound effects on short-term outcomes such as in-hospital mortality, which are widely used as markers of quality.13, 14 Inappropriate delays in care resulting from issues arising from ethnicity would be expected to have a significant impact on those requiring emergency surgery. However, this is unclear.
In England, Hospital Episode Statistics (HES) is an is an administrative dataset that collates information on all National Health Service (NHS) and private patients admitted to NHS hospitals in England on a per-episode basis. HES can monitor population-level outcomes following elective and emergency operations. Self-reported ethnicity is recorded in HES. HES data in recent years have high completeness of ethnic group information (typically exceeding 90%) and accurate in 95% of records when validated.15, 16, 17 There have been notable improvements in ethnicity recording in the past decade.
The aim of this study was to test if variations in outcomes (e.g. in-hospital mortality and length of hospital stay) exist by ethnic group in patients following emergency abdominal surgery.
Section snippets
Hospital Episode Statistics (HES)
A description of the HES database has been published previously.18 In brief, it is an administrative dataset that collates information on all NHS and private patients admitted to NHS hospitals in England. Each admission contains a primary diagnosis and secondary diagnoses which are categorised according to ICD-10 (international classification of diseases, 10th revision),19 along with patient-level demographic data including age, ethnicity and home postal code. This study is exempt from UK
General demographics
During the period of study 359,917 adult patients underwent emergency abdominal operations in England. Demographics are shown in Table 1. There was a fall in the percentage of people in which ethnicity was ‘not stated or known’ from 6.0% to 4.7% over the period studied, but still represented the second largest group (17,563 patients; 4.9% of overall cohort) after White British patients. The percentage of admissions where ethnicity was not recorded by region of residence in England is shown in
Discussion
Variations in-hospital mortality following surgery is important to patients and health service providers. There are a growing number of factors implicated including surgeon case-load, hospital volume and the day of the week operating.22, 23, 24, 25 This study found no evidence of detrimental outcomes for any named ethnic group. This would suggest that there are no identifiable barriers (e.g. cultural, linguistic or other) that impact upon the provision of emergency surgical care. The major
Acknowledgements
The authors would like to thank attendees at the Association of Surgeons of Great Britain and Ireland 2014 for their comments.
Ethical approval
This study is exempt from UK National Research Ethics Committee approval as it involved analysis of an existing dataset of anonymized data for service evaluation. A data sharing agreement with the Health and Social Care Information Centre (HSCIC) to use Hospital Episode Statistics data has been granted. Studies performed at the Department of Informatics, Queen Elizabeth
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Perioperative care of vulnerable populations
2023, Perioperative Care and Operating Room ManagementSpecial Considerations Related to Race, Sex, Gender, and Socioeconomic Status in the Preoperative Evaluation: Part 1: Race, History of Incarceration, and Health Literacy
2020, Anesthesiology ClinicsCitation Excerpt :Furthermore, African American men are disproportionately affected by both cardiovascular disease and prostate cancer, and increased cholesterol level has been shown to be a risk factor for recurrence of prostate cancer.10 By contrast, postoperative outcomes after abdominal surgery do not seem to differ by race.12,13 Predictors of difficult intubation also vary by race and ethnicity.
The effect of systematic factors on the outcome of trauma laparotomy at a major trauma centre in South Africa
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