Emergency abdominal surgery (EAS) is offered to people who experience a range of life-threatening conditions like bowel obstruction and gastrointestinal perforation. Equal access to effective high-quality emergency surgery is important for the publicly-funded Irish healthcare system. Although the quality of surgery can be measured by different means, population and individual based quality measurement of surgery is challenging. Existing national studies focus on outcomes like mortality and length of stay or on the volume of patients treated sometimes using simple case-mix measures like age, sex and ASA-scores. Validated composite scores have been developed in various types of surgery to describe case-mix and quality. Successful applications of such composite scores may offer new ways to evaluate outcomes from EAS and help to assess the quality of surgery at population and patient levels.
The HARM score is a composite measure that can be derived from routinely collected hospital data and is designed to be a low-cost outcome measure. The score is calculated using existing data on mortality, hospital readMsion and length-of-stay. Previous research has categorised surgical teams and hospitals based on the number of emergency operations they perform every year. Using data from the national quality assurance information system (NQAIS), we will perform a retrospective comparison of patient outcomes following EAS by different surgeons and hospitals. We will compare assessment based on surgical volume versus composite scores to explore how best quality of emergency surgery at population level can be measured.
