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Tuesday, December 13, 2011

Study reveals disturbing rate of failure among some surgeons

Thousands of patients are being forced to go under the knife for a second time because as many as half the operations carried out by some NHS surgeons end in failure.The disturbing finding comes from a study of bowel surgery, one of the commonest operations carried out on the NHS.

Patients whose bowel operations fail and have to be redone – usually because of bleeding, infection or leakage from the gut – face a four-fold increased risk of dying from surgery – up from 2.9 per cent to 11.9 per cent – and spend more than twice as long in hospital (27 days compared with 11).

There is growing concern in the NHS over variations in the quality of care between NHS trusts and individual surgical teams and about how to improve the outcomes of the poorest performers.

Researchers from Imperial College, London, investigated re-operation rates following bowel surgery to discover how wide the variation was and what might be done to boost performance. They examined almost 250,000 bowel operations conducted between 2000 and 2008 in England.

Predictably, the results showed that the trusts performing the most operations had the best results. But even among these there were wide variations, with re-operation rates ranging from 3.7 per cent to 11.5 per cent.

Overall almost 16,000 patients required further surgery to correct something that had gone wrong – one in every 15 procedures.

The study is published in the British Medical Journal. The worst-performing trusts and surgical teams are not named in the report, but an earlier study last April identified Burton Hospitals NHS Foundation Trust in Derbyshire as having the highest death rate following surgery for bowel cancer at 15.7 per cent, or one death in every 6.3 operations.

Omar Faiz, consultant colorectal surgeon and lead author of the study, said re-operation rates should be used with death rates to measure the quality of care in the NHS across a range of operations, provided the data was proved to be accurate.

Re-operation rates of 50 per cent were rare and reflected very unusual circumstances, such as when non-specialist surgeons were required to operate in emergencies.

“If there really are differences in performance that can’t be explained then the professional organisations will have to look at that,” he said.

Professor Norman Williams, president of the Royal College of Surgeons said the overall re-operation rate (6.5 per cent) was “quite impressive” and compared well with other countries. “We shouldn’t be complacent. If some surgeons truly have a 50 per cent re-operation rate it is extremely worrying.”

The college had said specialist surgery should be centralised in fewer hospitals and had encouraged surgeons to monitor performance.

Katherine Murphy of the Patients Association said: “We are supposed to have an NHS with patients at the centre, but it is still far from a patient-led service. They might get a choice of hospital but they are never given details of individual consultant performance, except in cardiac surgery. If they can do it in cardiac surgery why can’t we have it right across the NHS?

Teenage pregnancies are contagious

Teenage pregnancy are “contagious”, according to a study which has found that younger sisters tend to follow the example set by their older siblings.When an older sister becomes a gymslip mum, the younger sister is twice as likely to do the same.

This “peer effect”, as Bristol University researchers called it, raised the chances of becoming a teenage mother from about one in five to two in five.

The effect was stronger when sisters were closer together in age, while it was also stronger in poorer households.

Being educated to a higher level decreased its effect, but the research found that the sibling effect “dwarfs” that of more years in school.

Professor Carol Propper said: “Previous research has shown that family background and raising the education of girls decreases the chances of teenage pregnancy.

“However, these findings reveal the positive sibling effect still dwarfs the negative effect of education. These findings provide strong evidence that the contagious effect of teen motherhood in siblings is larger than the general effect of being better educated.

“This suggests that more policies aimed directly at decreasing teenage pregnancy may be needed in order to reduce teen births.”

The analysis was based on census data from 42,000 Norwegian women born after the Second World War. Most gave birth in the 1970s and 1980s.

The study, a collaboration with academics at Bergen University in Norway, the Norwegian School of Economics and Imperial College London, has been published as a working paper by Bristol University’s Centre for Market and Public Organisation.

UK has too many hospital births

Maternity services across the UK need a radical rethink, the Royal College of Obstetricians and Gynaecologists says.
It wants the number of hospital units cut to ensure 24-hour access to care from senior doctors and says more midwife-led units are needed for women with low-risk pregnancies.

The National Childbirth Trust welcomed the report but says the proposals do not go far enough.

NHS managers said maternity care desperately needed to be reorganised.

Too many babies are born in traditional hospital units, says the college, which also warns the current system is neither acceptable nor sustainable in its report on maternity care.

The college estimates there are about 1,000 too few consultants to provide adequate round-the-clock cover for hospital units.

Dr Falconer said: “There is no doubt if you look at the worst scenario of serious complications, you need the right person, a senior person, there immediately.”

Previous attempts to re-organise maternity care around a smaller number of hospital units have proved controversial, but Dr Falconer said if women could be convinced of the greater safety they would be prepared to travel to have their babies.

The need for change would be largely in cities or large towns, because in rural areas it might be more important to support smaller units.

The report estimates that across the UK there are 56 units with fewer than 2,500 deliveries of babies a year.

In order to take the pressure off busy hospitals, the college is also calling for an increase in the number of midwife-led units.

Midwives have welcomed the report, saying it could improve the experience for about a third of women who have straightforward deliveries.

The proposals for maternity are part of a wider vision of delivering all women’s gynaecology and obstetrics care in networks, similar to the model which has helped improve cancer treatments in England.

The National Childbirth Trust said the idea of having a network to provide joined-up care for women was one it could support but it would prefer care during pregnancy and maternity to be concentrated in one NHS organisation in each area.

The NHS confederation, which speaks for managers, described maternity care as a classic example of a service which desperately needed to be reorganised.

Chief executive Mike Farrar said politicians needed to be prepared to speak up for change.

“Where the case for change is clear, politicians should stand shoulder-to-shoulder with managers and clinicians to provide confidence to their constituents that quality and care will improve as a consequence of this change.”

Although Scotland has reorganised some of its maternity services, there are likely to be pressures for change elsewhere in the UK.

In North Wales maternity care across three hospitals is expected to change after an initial review recently concluded improvement was needed.

Weight Watchers twice as effective as nanny state advice for obese

Obese patients who enrol on commercial programmes such as Weight Watchers lose twice as much weight as those just given advice by the nanny state and doctors research suggests. A paper in the The Lancet found that overweight people who spent a year attending group meetings, being weighed regularly and following diet tips lost an average of 11.1lb (5.06kg).

This is twice the 4.9lb (2.25kg) shed by those who received weight-loss information at their local doctors’ surgery.

In addition, those on the Weight Watchers programme had lower cholesterol levels and smaller waist measurements, making them at lower risk of developing diabetes and heart disease.

Academics commenting on the study say public sector health services – such as the NHS – should consider paying for patients to attend private weight-loss classes than providing treatment themselves.

The study was carried out by Dr Susan Jebb at the UK Medical Research Council in Cambridge and colleagues but funded through a grant from Weight Watchers itself to the MRC.

It states that 1 billion people worldwide are overweight and 300 million obese, putting them at high risk of illness and early death and placing a heavy burden on healthcare systems.

The researchers took 770 overweight and obese patients, mainly middle-aged women, in Germany, Austria and Britain and gave half of them free access to a Weight Watchers programme while the others received “standard care” through their GP.

Those on the commercial scheme were encouraged to attend weekly weigh-ins as well as counselling and group support meetings, and were able to monitor their food intake and activity levels online as well as access meal ideas and take part in community discussions.

After 12 months, weight loss among those in Weight Watchers was “significantly greater” than those given GP advice, and they were twice as likely to have lost more than 5 per cent of their initial bodyweight.

In addition, their insulin, glucose and total cholesterol levels were found to be lower while their waist circumferences had dropped by an average 2.2in (5.60cm) compared with 1.2in (3.16cm) among those on the GP course. Both groups ended up with lower blood pressure.

The researchers say the commercial programme could be more successful at changing people’s behaviour because it offers more frequent weighing and peer support.

The paper claims it could also prove cheaper, at about £50-60 for 12 weeks, because it involves larger groups of people.

The authors conclude: “Data from our study suggest that referral by a primary health-care professional to a commercial weight loss programme that provides regular weighing, advice about diet and physical activity, motivation, and group support can offer a clinically useful early intervention for weight management in overweight and obese people that can be delivered at large scale.”

Kate Jolly and Paul Aveyard from the University of Birmingham write in an accompanying opinion piece: “Evidence that weight loss achieved by fairly brief interventions can be sustained long term without continued support would be valuable.

“However, present evidence shows that the commercial programme assessed by Jebb and colleagues provides a more effective weight management service than does primary care, and is widely available. Such programmes are likely to be an important component of the medical management of obesity in primary care.”

Women’s cancer rates higher in Britain than Europe

More British women are developing cancer than the average across Europe a leading charity claims.
Official figures suggest almost a fifth more women in this country develop the disease before the age of 75 compared with those on the continent.

The World Cancer Research Fund, which unearthed the data, fears that the difference could be down to the fact that British women drink and eat too much.

Dr Rachel Thompson, Deputy Head of Science for WCRF, said: “On average, women in the UK are more likely to be overweight and to drink more alcohol than the European average and this is a concern because both these factors increase cancer risk.

“They are not the only reasons for the differing cancer rates, but there is now very strong evidence that women who drink a lot of alcohol are at increased risk of developing the disease and that excess body fat is also an important risk factor.

“This is why one of the big public health challenges we face today is to reduce the amount of alcohol we drink as a nation and to get a grip on the obesity crisis before it spirals out of control.

“Together with other factors such as being physically active and eating a healthy plant-based diet without too much salt or red and processed meat, these changes could make a real difference to the number of women who develop cancer before the age of 75.

“Overall, we estimate about a third of the most common cancers could be prevented by eating healthily, being physically active and maintaining a healthy weight. And for breast cancer, which is the most common type of cancer, about four in 10 cases could be prevented through lifestyle changes.”

Recent estimates suggest that four out of 10 Britons will develop cancer at some point in their lives.

The Office for National Statistics reported last month that 130,043 women were newly diagnosed with the disease in England alone in 2009, a rise of 2.6 per cent on the previous year.

By far the most common type among females is breast cancer, with 40,260 cases in 2009. About a quarter of those who develop such tumours die, despite widespread screening and the development of better drugs in recent decades.

According to World Health Organisation figures, 25 per cent of women across Britain develop cancer by the age of 75.

This is almost 20 per cent more than the average of 21 per cent recorded across Europe.

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