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Title: Outcomes from surgery
Author: Rhodes, Andrew
Awarding Body: St George's, University of London
Current Institution: St George's, University of London
Date of Award: 2013
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This thesis explores the utility of critical care following surgery. In particular, it assesses whether there are differences in how countries provide for critical ca re following surgery and whether these impact on outcomes. A meta-analysis of pre-emptive haemodynamic interventions in surgery was shown to reduce complications and mortality. Many of these interventions required the use of critical care which limited their utility. An analysis of a quality Austrian critical ca re database enabled an understanding of the group of patients admitted to critical care following surgery and the factors that are important in determining outcome. By utilizing these factors in a hierarchical logistic regression model, I demonstrated that outcomes are improving. Unfortunately, the provision of healthcare is not the same throughout Europe. Extrapolating data from Austria to the United Kingdom is therefore difficult. A further study was completed to identify differences in critical care provision between European countries. This study was hampered by inconsistent definitions of what an intensive care bed is, although did find a worryingly wide difference in beds per head of population. This must have implications for the case mix of patients admitted (or refused) to critical ca re and therefore surgical outcomes. A final study was performed to assess whether there were differences in outcomes at a national level. In this large observational study, critical care utilization varied following surgery and mortality rates were higher than expected with significant differences found between individual countries. In conclusion, critical care is a vital part of the surgical pathway for a select group of patients. Unless this group can be understood and quantified, then healthcare providers will be unable to develop systems that are able to cope with the likely demand. Only by matching this demand will optimal ca re be delivered.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available