ESORT: Evaluating the effectiveness of emergency surgery for patients with acute conditions

Many patients are admitted to NHS hospitals in an emergency with common acute conditions. Some have emergency surgery within days and others have another approach to care, for example drug treatment or surgery later. We do not know if the benefits emergency surgery are greater than alternative approaches to care. The ESORT study assessed the effectiveness and cost-effectiveness of emergency surgery in patients with appendicitis, gallstone disease, diverticular disease, abdominal hernia or intestinal obstruction. The study used routine NHS data. Innovative methods were used to overcome common problems with routine data, for example, the lack of detailed information on the severity of disease. 

This study evaluated the relative effectiveness and cost-effectiveness of emergency general surgery compared to non-operative strategies for patients with acute conditions. We are using data from Hospital Episode Statistics for patients who present as emergency admissions to NHS Trust hospitals in the UK.

This study is part of the NIHR ESORT (Emergency Surgery – Or noT) project, which aimed to determine the effectiveness and cost-effectiveness of emergency surgery for patients with common acute conditions presenting as emergency hospital admissions. 

For more detail on the range of work done, click these links:

• How does a local instrumental variable method perform across settings with instruments of differing strengths? A simulation study and an evaluation of emergency surgery
• Adapting Patient and Public Involvement processes in response to the Covid-19 pandemic
• Impact of the first wave of COVID-19 on outcomes following emergency admissions for common acute surgical conditions: analysis of a national database in England
• Effectiveness of emergency surgery for five common acute conditions: an instrumental variable analysis of a national routine database
• Variation in the rates of emergency surgery amongst emergency admissions to hospital for common acute conditions
• Emulating target trials with real-world data to inform health technology assessment: findings and lessons from an application to emergency surgery
• Local instrumental variable methods to address confounding and heterogeneity when using Electronic Health Records: an application to emergency surgery

We found that people tended to have similar outcomes and costs, regardless of whether they had emergency surgery or another approach to care. However, for some subgroups, we did find important differences. For people who were very frail, other approaches to care led to greater benefits.

London School of Hygiene and Tropical Medicine (LSHTM)