Mortality following surgical services reconfiguration in the Mid-West

Background: Following prolonged consultations, the health service in Ireland is now engaged in a series of service reconfigurations. This involves centralisation of acute surgical services. There have been concerns that the withdrawal of acute surgical services from smaller hospitals will result in excess mortality, due to diagnostic delay and transfers. As yet, there has been no analysis of mortality data. Methods: The Hospital In-Patient Episode database was interrogated to identify all surgical episodes in the Mid-West Region for the year before and year after surgical service reconfiguration. All surgical specialities (general surgery, vascular surgery, orthopaedics, ophthalmology, otorhinolaryngology, urology, maxillofacial surgery) were included. Poisson mortality rates were calculated and used to determine the effect of reconfiguration on the standardised mortality rate. Results: In the year preceding reconfiguration, the incidence rate estimate for death was 0.001268 per day (95% CI: 0.001025 0.001552) (94 deaths from 74,105 patient days). Using these data as a baseline, in the year following reconfiguration, 87 deaths would be expected. 88 deaths were observed (SMR 1.01; 95% CI: 0.811.25). There was no significant difference in the observed to expected mortality (p = 0.464). The analysis was repeated for general surgicalpatients requiring emergency surgery. Following reconfiguration, 18 deaths were expected but only 13 were observed (SMR 0.73; 95% CI: 0.391.26; p = 0.16). Conclusion: There has been no increase in mortality due to the centralisation of acute surgical services in the Mid-West. Further data are required to determine whether centralisation reduces mortality following emergency general surgery. Conflict of interest: None. Disclosures: None.