Accuracy rates are improving. Current levels of reported accuracy suggest that routinely collected data are sufficiently robust to support their use for research and managerial decision-making.

The performance of a given comorbidity measure depends on the patient group and outcome. In general, the Elixhauser index seems the best so far, particularly for mortality beyond 30 days, although several newer, more inclusive measures are promising.

Objective To estimate the number of deaths and readmissions associated with delay in operation after femoral fracture. Design Analysis of inpatient hospital episode statistics. Setting NHS hospital trusts in England with at least 100 admissions for fractured neck of femur during the study period. Main outcome measuresIn hospital mortality and emergency readmission within 28 days. Results There were 129 522 admissions for fractured neck of femur in 151 trusts with 18 508 deaths in hospital (14.3%). Delay in operation was associated with an increased risk of death in hospital, which was reduced but persisted after adjustment for comorbidity. For all deaths in hospital, the odds ratio for more than one day's delay relative to one day or less was 1.27 (95% confidence interval 1.23 to 1.32) after adjustment for comorbidity. The proportion with more than two days' delay ranged from 1.1% to 62.4% between trusts. If death rates in patients with at most one day's delay had been repeated throughout all 151 trusts in this study, there would have been an average of 581 (478 to 683) fewer total deaths per year (9.4% of the total). There was little evidence of an association between delay and emergency readmission. Conclusions Delay in operation is associated with an increased risk of death but not readmission after a fractured neck of femur, even with adjustment for comorbidity, and there is wide variation between trusts.

Objectives To assess the association between mortality and the day of elective surgical procedure.Design Retrospective analysis of national hospital administrative data.Setting All acute and specialist English hospitals carrying out elective surgery over three financial years, from 2008-09 to 2010-11.Participants Patients undergoing elective surgery in English public hospitals.Main outcome measure Death in or out of hospital within 30 days of the procedure.Results There were 27 582 deaths within 30 days after 4 133 346 inpatient admissions for elective operating room procedures (overall crude mortality rate 6.7 per 1000). The number of weekday and weekend procedures decreased over the three years (by 4.5% and 26.8%, respectively). The adjusted odds of death were 44% and 82% higher, respectively, if the procedures were carried out on Friday (odds ratio 1.44, 95% confidence interval 1.39 to 1.50) or a weekend (1.82, 1.71 to 1.94) compared with Monday.Conclusions The study suggests a higher risk of death for patients who have elective surgical procedures carried out later in the working week and at the weekend. IntroductionA substantial number of patients die as a result of unsafe medical practices and care during their admission to hospital.1 Previous research carried out with English hospital data has suggested a significantly higher risk of death if patients are admitted as an emergency at the weekend compared with a weekday. 2 Other papers have described the "weekend effect"-that is, a worse outcome for patients admitted at weekends compared with weekdays in terms of (in and out of hospital) mortality or length of stay in hospital. [3][4][5] Other studies, however, have found no such effect. 6 Most previous work has focused on acute admissions. A study looking at Veteran Affairs' hospitals in the United State found an increased 30 day mortality (deaths in hospital and after discharge) after non-emergency surgery on Fridays versus early weekdays in patients admitted to regular hospital wards (that is, excluding intensive care units). 7 A recent Australian study reported that after hours and weekend admissions to intensive care units are associated with increased hospital mortality, with the results attributed mainly to patients with planned admissions after elective surgery. 8 A recent English study found an increased risk of hospital death in the elective setting for weekend admissions but, critically (like most previous studies), focused on the day of admission, rather than day of procedure and did not include out of hospital deaths, a potential source of bias. 9There are at least two potential explanations for finding worse outcomes in patients in hospital at the weekend. The first is that these differences reflect poorer quality of care at the weekend, and the second is that patients admitted or operated on at the weekend are more severely ill than those admitted during the week. Some research has proposed reduced staffing levels or less senior and less experienced staff at the weekends as an explana...

This is the largest study published on weekend mortality and highlights an area of concern in relation to the delivery of acute services.

ObjectiveTo examine the timing and duration of RSV bronchiolitis hospital admission among term and preterm infants in England and to identify risk factors for bronchiolitis admission.DesignA population-based birth cohort with follow-up to age 1 year, using the Hospital Episode Statistics database.Setting71 hospitals across England.ParticipantsWe identified 296618 individual birth records from 2007/08 and linked to subsequent hospital admission records during the first year of life.ResultsIn our cohort there were 7189 hospital admissions with a diagnosis of bronchiolitis, 24.2 admissions per 1000 infants under 1 year (95%CI 23.7–24.8), of which 15% (1050/7189) were born preterm (47.3 bronchiolitis admissions per 1000 preterm infants (95% CI 44.4–50.2)). The peak age group for bronchiolitis admissions was infants aged 1 month and the median was age 120 days (IQR = 61–209 days). The median length of stay was 1 day (IQR = 0–3). The relative risk (RR) of a bronchiolitis admission was higher among infants with known risk factors for severe RSV infection, including those born preterm (RR = 1.9, 95% CI 1.8–2.0) compared with infants born at term. Other conditions also significantly increased risk of bronchiolitis admission, including Down's syndrome (RR = 2.5, 95% CI 1.7–3.7) and cerebral palsy (RR = 2.4, 95% CI 1.5–4.0).ConclusionsMost (85%) of the infants who are admitted to hospital with bronchiolitis in England are born at term, with no known predisposing risk factors for severe RSV infection, although risk of admission is higher in known risk groups. The early age of bronchiolitis admissions has important implications for the potential impact and timing of future active and passive immunisations. More research is needed to explain why babies born with Down's syndrome and cerebral palsy are also at higher risk of hospital admission with RSV bronchiolitis.

of primary care and social medicine 2 ABSTRACT Objective To compare risk prediction models for death in hospital based on an administrative database with published results based on data derived from three national clinical databases: the national cardiac surgical database, the national vascular database and the colorectal cancer study. Design Analysis of inpatient hospital episode statistics. Predictive model developed using multiple logistic regression. Setting NHS hospital trusts in England. Patients All patients admitted to an NHS hospital within England for isolated coronary artery bypass graft (CABG), repair of abdominal aortic aneurysm, and colorectal excision for cancer from 1996-7 to 2003-4. Main outcome measures Deaths in hospital. Performance of models assessed with receiver operating characteristic (ROC) curve scores measuring discrimination (<0.7=poor, 0.7-0.8=reasonable, >0.8=good) and both HosmerLemeshow statistics and standardised residuals measuring goodness of fit. Results During the study period 152 523 cases of isolated CABG with 3247 deaths in hospital (2.1%), 12 781 repairs of ruptured abdominal aortic aneurysm (5987 deaths, 46.8%), 31 705 repairs of unruptured abdominal aortic aneurysm (3246 deaths, 10.2%), and 144 370 colorectal resections for cancer (10 424 deaths, 7.2%) were recorded. The power of the complex predictive model was comparable with that of models based on clinical datasets with ROC curve scores of 0.77 (v 0.78 from clinical database) for isolated CABG, 0.66 (v 0.65) and 0.74 (v 0.70) for repairs of ruptured and unruptured abdominal aortic aneurysm, respectively, and 0.80 (v 0.78) for colorectal excision for cancer. Calibration plots generally showed good agreement between observed and predicted mortality. Conclusions Routinely collected administrative data can be used to predict risk with similar discrimination to clinical databases. The creative use of such data to adjust for case mix would be useful for monitoring healthcare performance and could usefully complement clinical databases. Further work on other procedures and diagnoses could result in a suite of models for performance adjusted for case mix for a range of specialties and procedures.

Minimally invasive esophagectomy is increasingly performed in the United Kingdom. Although the study confirmed the safety of MIE in a population-based national data, there are no significant benefits demonstrated in mortality and overall morbidity. Minimally invasive esophagectomy is associated with higher reintervention rate. Further evidence is needed to establish the long-term survival of MIE.