Accès ouvert déclaré
2019
article
Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial
Carol J. Peden, Tim Stephens, Graham Martin, Brennan C Kahan, Ann Thomson, Kate Rivett, Duncan Wells, Gerry Richardson, Sally Kerry, Julian Bion, Rupert M. Pearse, Stephen J. Brett, Gareth L. Ackland, Peter Holt, Glenn Robert, Obioha C. Ukoumunne, J. B. H. Waring, Kirsty Everingham, Mandeep Phull, David Cromwell, Rachel Evley, Richard Lilford, David Kocman, Miqdad Asaria, Carolyn Tarrant, Fan Yang, Ajit Abraham, Pieter Bothma, Daniel Conway, C Stapleton, Mark Edwards, Gary Minto, David Saunders, Tom Owen, Carl Waldmann, Paul Hayden, Michael Gillies, Sean Tighe, Neil Smith, Monty Mythen, David J. Murray, Dileep N. Lobo, M. Leuwer, Justin Kirk-Bayley, Simon Howell, Anthony Gordon, I D Anderson, Jose Lourtie, Simon Walker, Sharon Drake, Dave Murray, Nick Watson, Tamás Szakmány, Robert P. Sutcliffe, Ravi Mahajan, Alan Girling, Gordon Forbes, Omar Faiz, Mark Blunt, Surjait Singh, Alistair Steel, Kate Wong, Leilani Cabreros, Vivek Chitre, A. Obideyi, Dhiraj Ali, Karl Blenk, Dan Broad, Andreas Brodbeck, Rajesh Dumpala, A. Engel, Ranjit Ganepola, Sudha Garg, Mike Gay, Michael Karlikowsk, Edward Lams, Dean Millican, Inga Misane, Ajaya Mull, Nathan Pushpa, Chris Nutt, Saravanna Sagadai, Hazel Stuart, Paul W. Noble, Niko Van De Velde, Liam Hudson, Raoul Benlloch, Satish S. Singh, Karan Verma, D Laba, Jack Carmichael, Peter Richardson, Graham Wilson, Ricky Lewis, Karthik Surendran, Essam El-Damatty, Sarada Gurung, Ilona Raulusaite, Nabua Gerstina, C. G. Rochester, Rai Kuldip, Andrew M. Lindner, Therese Murray, Roshan Lal, Sarah Downey, Vamsi Velchuru, Kamal Aryal, Raman Guruswamy, Kirosh Shankar, Helen Porter, Matthew G. Tutton, Helen Agostini, Simon P. Fletcher, Richard Wharton, S Hutchinson, Bala Maiya, Richard Howard-Griffin, Michael Crabtree, Vlad Kushakovsky, Abdel Omer, Senthil Nadarajavan, Stephanie Bell, Vishal Patil, Asif Jah, Razeen Mahroof, Nicholas Watson, John Tansley, Gareth Moncaster, Neil Flint, Andrew G Miller, Marcus de Wood, Andreou Prematie, Sally Roth, Sarah Bowery, Dawn Hales, Tanuja Shah, Gillian Tierney, C. Morris, Syed Yusuf Iftikhar, Amit Shukla, Grainne O'Dwyer, Adam Wolverson, Ferdinand Adams, Laura Perrin-Brown, T. R. White, Sarah Beavis, Victoria Banks, J F Abercrombie, J P Molé, Avninder Chana, Ayan Banerjea, David J. Humes, Rajpal Dhingsa, John Paul Wells, Stephanie Brown, Kenneth Adegoke, Barclay Tofte, Ana Alegria, Nat Natarajan, Mansoor Akhtar, Samer Doughan, John Mackinnon, Biju Aravind, Esther Cook, Mark Snazelle, Matt Gardner, Lee Baldwin, Simon Bailey, Neil Kukreja, Mansoor Sange, Mark Watson, Mallikarjunappa Satisha, Michael Protopapas, Zakaulla Belagodu, Shameem Sarfi, Brenda Stacey, Tim Campbell-Smith, Simon J. Parrington, Somi Desikan, Andrew Brennan, J Griffith, Steve Fletcher, Catherine Farrow, Stewart Prestwich, Laura A. Graham, Martin Northey, Jay Gokhale, Frances Mosley, Peter Alexander, Abhiram Sharma, Will Brady, John L. Hopper, Oliver W. Hill, Sandeep Varma, Christopher Macklin, Alastair Rose, Harjeet Singh Narula, Sarah Buckley, Karen Simeson, Kevin Sim, Michael Chadwick, Preeti Kuduvalli, Susan Dowling, Amanda McCairn, Lawrence Wilson, Dale Vimalchandran, Anita Jhamatt, Nicole Robin, David Bottomley, O. Zuzan, Ingeborg Welters, Davina Ross‐Anderson, Charles H. Knowles, Nick Bunker, Ying Hu, Marta Januszewska, Phoebe Bodger, Edyta Niebrzegowska, Carmen Correia, Richard Haslop, Tom Abbott, Tabitha Tanqueray, Sanjay Wijeykoon, Susan Jain, Jens Full, Tamzin Cuming, Flora L. Bailey, Stelios Chatzimichail, Pedro Cunha, Almas Rehman, Manab Mohanty, N. J. Radford, O Mohr, D Mateo, Ashok Raj, Michael Machesney, Nazar Abdul, Kim Jemmet, Marta Campbell, David W. Inglis, Thomas G. Parker, Thomas Medici, Peter Chan, Nathan Borgeaud, Dipankar Mukherjee, Oluremi Odejinmi, Tomas Jovaiša, Elizabeth Harwood, Ramani Moonesinghe, Jonathan McCullough, Jigna Modha, Sanjiv Patel, James Limb, Sheshagiri Bengeri, Amir Rafi, Elizabeth J. Hall, Bruce Gibson, Una McNelis, Mike Bradburn, Maria Lawson, Sara Pick, Matthew Gaughan, David Browell, Vanessa Linnett, Jenny Ritzema, Paul O’Loughlin, Sean Cope, John D. Corson, Alistair Roy, Julie Furneval, A. M. Holtham, Sophie Noblett, Chris Dawson, Fiona McMenemie, Stefan Pulsa, I Clement', Verity Calder, Katherine Allen, Catherine A. Rimmer, Helen D. Reed, Christine Boyd, Diane Monkhouse, Peter V. Davies, Jost Müllenheim, Emanuel Cirstea, Martyn Cain, Kirsty Baillie, Arnab Bhowmick, Keiarash Jovestani, Sean Mcmullan, Emma Durant, Alexandra Williams, Donna Doyle, Jason Cupitt, J.A. Barker, N. Harper, Emma Brennan, Daren Subar, Robert Shawcross, Dominic Sebastian, Panna Patel, Gillian M. O’Connell, Jyrki Karvonen, Maitra Ishaan, Alison Hool, Karen Burns, Carol McArthur, Tezas Stergios, Singh Gursevak, Makvana Sonia, Heather Pratt, Kaighan Lynne, S. J. McAfee, Chris Lewis, Wael Khalaf, Chris H Coldwell, Christine Bronder, Mark Wilkinson, Emma Davis, Glenn Arnold, Paul Ziprin, Rachel Bartlett, Martin Stotz, Rovan D’Souza, P. J. Pemberton, Banwari Agarwal, Anita Sugavanam, Melanie Tan, M Varcada, Craig Lyness, Andrew Thorniley, A Prabhudesai, Ruth Griffin, Shubha Vashisht, James Harris, Julie Wakeford, Sergei Vaganov, Yasser Mohsen, Alister Myers, Qamar Iqbal, Simon Harris, Sami Ijaz, James N. Burrow, Francesca Rubulotta, Nabil El-Masry, Nicola Stranix, Tamsin Rope, Lampros Liasis, Tariq Husain, J Watfah, Megan Griffiths, Janindra Warusavitarne, Charles P. Cartwright, Linden Baxter, Rakhee Visavadia, Malcolm Sim, Chris Wilson, Paul Harrison, Dewi Williams, Maria Bews-Hair, Wayne Wrathall, Catherine Jardine, P McLaren, Fanus Dreyer, Paddy Collins, Jennifer Edwards, Susan Moug, Kevin Rooney, Erin Mcilveen, Steven Henderson, Linda J. Graham, G Stark, Lynn Taylor, Mark Munro, Lynn A. Stewart, Natalie Dickinson, Laura Rooney, Lindsay Bailey, Diane Murray, Tim Geary, Simon C. Gibson, Colin Pow, Kerwei Tan, Richard D. Stevenson, Ewen M. Harrison, Peter Lamb, Kate A. Carey, Laura Fitton, Fabian Cook, Magen Schwarz, Alan Morrison, Gavin Bryce, Khaled Razouk, Kathryn Cain, Gudrun Kunst, Savvas Papagrigoriadis, Philip Hopkins, Adrian Fawcet, B. O'Carroll-Kuehn, Amira Girgis, Stas Janokowski, Sami Farhat, Stella Vig, Nada Hadi, Anthony Parsons, Maurizio Cecconi, David M. Melville, Richard Hartopp, Justin Woods, Isabella Karat, David Gerrard, Edward B. Curtis, K Somasekar, Tom Morgan-Jones, Michael Martin, Mark Henwood, Gordon Milne, Ajit Sivasankaranand, Alexandra Scott, Xavier Escofet, Piroska Toth-Tarsoly, Majed Al Shama, Valerie Hilton, Huw Davis, Gail Williams, T Harvard, Peter J. Fitzgerald, Dom Hurford, Babu Muthuswamy, G. L. Williams, J. Jones, Nick Mason, R. Rajagopal, Shrisha Shenoy, Magdy Khater, Richard A. Morgan, Nikolaos Makris, Anil Hermandes, Andrew A. White, Guy Finch, M Outram, Jonny Wilkinson, Jennifer Spimpolo, Marion Obichere, Giovanni Brescia, Flávia da Silva Menezes, Helena Stafford, Malcolm Watters, Chris Thorn, Julian Stone, Sam Andrews, Nicola Lythell, Helen Langton, Stephen Baxter, R. Fernandes, R. Sunthareswaran, Alastair Ankers, K. Panikkar, Simon Sleight, Belinda Cornforth, Louise Bell, Phil Dodd, Fenella K.S. Welsh, Geoff Watson, Frankie Dorman, Guy F Nash, James Bromilow, Fran Haigh, David Pogson, Stuart Mercer, Vanessa Tucker, Carolyn Way, James Kirby-Bott, Jenny McLachan, Robert Chambers, Rachael Craven, Jane Blazeby, Dan Freshwater-Turner, Lorna Burrows, H. Howes, I. Christie, Mark Coleman, Sam Waddy, Grant Sanders, Abigail Patrick, Catherine L. Pitman, Susan Tyson, Hannah Smith, Guy Rousseau, Mark Cartmell, Jan Hanousek, Nigel Hollister, Lynsey Kightly, Mark Pulletz, Anjay Talwar, Susie Baker, Ruth Thomas, Richard Gibbs, Hamish Noble, Joseph Silsby, Helen Black, Thomas Evans, Robert deBrunner, Nicola Cook, Stacy Hodges, Amanda Stevens, R. Z. Felipe, Jonathan Paddle, Denzil May, Alison Pickford, Sid Riddington, Olga Tucker, Simon M. Smart, Jeremy Marwick, Nigel Suggett, Ewen A. Griffiths, D. W. Riddington, Kathryn Gill, Neil Cruickshank, Jaysimha Susarla, Emma Leno, Julie Colley, Andrew Burtenshaw, Stephen Lake, Jamie Greenwood, Sian Bhardwaj, Jessica Thrush, Julie Wollaston, Julian Sonksen, Rajan Patel, Adrian Jennings, David Stanley, Jenny Wright, Chris Horner, Faisal Baig, K Cooke, Jagdeep Singh, Andrew R. Claxton, Nazzia Mirza, Simon Hester, Georgia Knight, Peeyush Kumar, Taj Saran, Gabriele Marangoni, Andy Thacker, Anne Scase, Meghna Sharma, Beth Hale
191Citations signalées — pas une note de qualité
7Institutions déclarées
2Pays d’affiliation déclarés
Résumé fourni par la source
BACKGROUND: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. METHODS: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. FINDINGS: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96-1·28). INTERPRETATION: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. FUNDING: National Institute for Health Research Health Services and Delivery Research Programme.
Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.
Contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial
- Date Crossref
- 01/06/2019
- Éditeur
- Elsevier BV
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude et ne compte pas comme une seconde source scientifique indépendante.
Institutions déclarées
Une affiliation ne permet pas de déduire la nationalité d’un auteur.
Sujets associés
Cardiac, Anesthesia and Surgical OutcomesTrauma and Emergency Care StudiesEnhanced Recovery After Surgery