![]() Surprisingly we found a small trend towards a reduction in the overall risk profile in recent years (IRAD score) due to less patients undergoing surgery in critical conditions. In this time we noted an almost doubling of the total number of operations performed as well as the number of operations performed per surgeon and per center. We presented a decade long report on over 3600 patients operated on for type A aortic dissection in England from 2009 to 2018. Indices of Multiple Deprivation Tercile (%) Expected risk was assessed using a validated risk prediction model, the International Registry of Aortic Dissection (IRAD) score [Īnnual operative volume per surgeon (mean (SD)) For each patient, surgeon and hospital annual volume relative to the year of surgery was derived. We also reported on socioeconomic status using terciles the Index of Multiple Deprivation (IMD), which is obtained by combining information from seven domains to give a summative relative measure of deprivation (0 corresponds to most deprived areas and 10 least deprived). A set of variables related to clinical presentation and operative data were obtained. All procedures included in the present analysis were classified under the heading of urgent (non-elective admission with need for surgery during the same admission), emergency (operation before the next working day) or salvage (patients needing cardiopulmonary resuscitation on route to theater or before anesthetic induction). Missing categorical or dichotomous variable data were imputed with the mode while missing continuous variables data imputed with the median.įor the present analysis, from the NACSA registry we identified patients undergoing surgery for TAAD from January 2009 to December 2018 in England. The overall percentage of missing data for baseline information is very low (1.7%). Missing and conflicting data for in-hospital mortality status are backfilled and validated via record linkage to the Office for National Statistics (ONS) census database. Most missing data are resolved during the validation stages of the data transfer from individual centers. At this stage, and prior to analysis, data for the last 3 years are returned to each contributing hospital for local validation, and units update their records in the central registry repository where necessary. All cleaning is made reproducible by programming a series of scripts, which are updated following each new data extract. The data cleaning is performed by the analyst responsible for the governance analysis in collaboration with surgeons and the audit manager. Briefly, duplicate records are removed, transcriptional discrepancies re-coded and clinical and temporal conflicts resolved. The Lancet Regional Health – Western Pacific.The Lancet Regional Health – Southeast Asia.The Lancet Gastroenterology & Hepatology.
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