Constructing the entire care pathway of bowel cancer patients undergoing emergency surgery to improve care

Patients having emergency bowel surgery receive care that is informed by national guidelines, but the evidence supporting these guidelines is limited. Furthermore, the impact of specific long-term conditions and combinations of multiple long-term conditions (MLTCs) in these patients is not known. The information needed to better inform this care (such as patients’ tumour pathology, long-term health conditions, care received, outcomes of care) is available, but is collected in several separate datasets.

We have therefore developed improved methods for linking multiple datasets and risk-adjustment. We can then identify aspects of care with the greatest impact on patient outcomes.

Our findings will help hospitals and clinicians to improve care for patients undergoing emergency bowel surgery, and will add to the evidence for new guidelines. Understanding the impact of MLTCs on patients undergoing emergency bowel surgery can also inform clinical decision-making, patient counselling of risk, and policy decisions on resourcing optimal care.

The study led to new methods that will allow more studies using linked clinical datasets, minimising costs and delays while protecting the security of patient data.

These methods enable improved risk prediction, allowing fairer comparisons between patients who receive different types of care.

In addition, they facilitate the evaluation of the effectiveness of other care processes on outcomes of emergency bowel cancer surgery.

In September 2022, ARC and LSHTM researcher Helen Blake presented two oral presentations at the International Population Data Linkage Network conference in Edinburgh, on: 'Linkage of national clinical datasets without patient identifiers using probabilistic methods.' and 'Linkage of multiple electronic health record datasets using a "spine linkage" approach compared to all "pairwise linkages".

In July 2021, ARC and UCL researcher Helen Blake presented her poster 'Probabilistic linkage without person information successfully linked national clinical datasets' at the 42^nd Conference of the International Society for Clinical Biostatistics (ISCB) 2021. View the poster. 

London School of Hygiene & Tropical Medicine (LSHTM)

Royal College of Surgeons of England (RCSEng)

University College London (UCL)

Intensive Care National Audit & Research Centre (ICNARC)

Manchester University NHS Foundation Trust (MFT)