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Surgical risks associated with winter sport tourism.

Sanchez S, Payet C, Lifante JC, Polazzi S, Chollet F, Carty MJ, Duclos A - PLoS ONE (2015)

Bottom Line: We computed multilevel regressions to evaluate whether significant increase in emergency cases had an effect on surgical mortality, complications and length of stay.Clustering effect of patients within hospitals was integrated in analysis and surgical outcomes were adjusted for both patient and hospital characteristics.After controlling for potential confounders, patients did not experience increased risk for postoperative death (ratio of OR 1.01, 95%CI 0.89-1.14, p = 0.891), thromboembolism (0.95, 0.77-1.17, p = 0.621) or sepsis (0.98, 0.85-1.12, p = 0.748).

View Article: PubMed Central - PubMed

Affiliation: Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, Lyon, Rhône, France; Université Claude Bernard Lyon 1, Faculté de médecine Lyon Est, Lyon, Rhône, France.

ABSTRACT

Background: Mass tourism during winter in mountain areas may cause significant clustering of body injuries leading to increasing emergency admissions at hospital. We aimed at assessing if surgical safety and efficiency was maintained in this particular context.

Methods: We selected all emergency admissions of open surgery performed in French hospitals between 2010 and 2012. After identifying mountain areas with increasing volume of surgical stays during winter, we considered seasonal variations in surgical outcomes using a difference-in-differences study design. We computed multilevel regressions to evaluate whether significant increase in emergency cases had an effect on surgical mortality, complications and length of stay. Clustering effect of patients within hospitals was integrated in analysis and surgical outcomes were adjusted for both patient and hospital characteristics.

Results: A total of 381 hospitals had 559,052 inpatient stays related to emergency open surgery over 3 years. Compared to other geographical areas, a significant peak of activity was noted during winter in mountainous hospitals (Alps, Pyrenees, Vosges), ranging 6-77% volume increase. Peak was mainly explained by tourists' influx (+124.5%, 4,351/3,496) and increased need for orthopaedic procedures (+36.8%, 4,731/12,873). After controlling for potential confounders, patients did not experience increased risk for postoperative death (ratio of OR 1.01, 95%CI 0.89-1.14, p = 0.891), thromboembolism (0.95, 0.77-1.17, p = 0.621) or sepsis (0.98, 0.85-1.12, p = 0.748). Length of stay was unaltered (1.00, 0.99-1.02, p = 0.716).

Conclusion: Surgical outcomes are not compromised during winter in French mountain areas despite a substantial influx of major emergencies.

No MeSH data available.


Related in: MedlinePlus

Variations in hospitals emergency admissions for open surgery during winter compared to control seasons.Variations in hospitals emergency admissions for open surgery during winter are depicted in a geographic representation. Three colours (light 5 to 29% increase; medium 30 to 59% increase; dark over 60% increase) identify geographical areas with significant increasing volume of stays during winter. Their volume of stays during winter was increased by at least 5% and greater than the 95% confidence interval compared to control season.
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pone.0124644.g001: Variations in hospitals emergency admissions for open surgery during winter compared to control seasons.Variations in hospitals emergency admissions for open surgery during winter are depicted in a geographic representation. Three colours (light 5 to 29% increase; medium 30 to 59% increase; dark over 60% increase) identify geographical areas with significant increasing volume of stays during winter. Their volume of stays during winter was increased by at least 5% and greater than the 95% confidence interval compared to control season.

Mentions: A total of 381 French hospitals had 559,052 inpatients stays related to open emergency surgery from 2010 to 2012 in winter and control season. Geographical areas having experienced a significant increase in the volume of emergency admission linked with open surgery procedures during winter are shown in Fig 1. These were mainly located in mountainous areas where tourists could practice winter sports. Activity increases were noted in 35 hospitals and ranged from 6% in Vosges to 15% in Pyrenees and as high as 77% in the Alps.


Surgical risks associated with winter sport tourism.

Sanchez S, Payet C, Lifante JC, Polazzi S, Chollet F, Carty MJ, Duclos A - PLoS ONE (2015)

Variations in hospitals emergency admissions for open surgery during winter compared to control seasons.Variations in hospitals emergency admissions for open surgery during winter are depicted in a geographic representation. Three colours (light 5 to 29% increase; medium 30 to 59% increase; dark over 60% increase) identify geographical areas with significant increasing volume of stays during winter. Their volume of stays during winter was increased by at least 5% and greater than the 95% confidence interval compared to control season.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4430272&req=5

pone.0124644.g001: Variations in hospitals emergency admissions for open surgery during winter compared to control seasons.Variations in hospitals emergency admissions for open surgery during winter are depicted in a geographic representation. Three colours (light 5 to 29% increase; medium 30 to 59% increase; dark over 60% increase) identify geographical areas with significant increasing volume of stays during winter. Their volume of stays during winter was increased by at least 5% and greater than the 95% confidence interval compared to control season.
Mentions: A total of 381 French hospitals had 559,052 inpatients stays related to open emergency surgery from 2010 to 2012 in winter and control season. Geographical areas having experienced a significant increase in the volume of emergency admission linked with open surgery procedures during winter are shown in Fig 1. These were mainly located in mountainous areas where tourists could practice winter sports. Activity increases were noted in 35 hospitals and ranged from 6% in Vosges to 15% in Pyrenees and as high as 77% in the Alps.

Bottom Line: We computed multilevel regressions to evaluate whether significant increase in emergency cases had an effect on surgical mortality, complications and length of stay.Clustering effect of patients within hospitals was integrated in analysis and surgical outcomes were adjusted for both patient and hospital characteristics.After controlling for potential confounders, patients did not experience increased risk for postoperative death (ratio of OR 1.01, 95%CI 0.89-1.14, p = 0.891), thromboembolism (0.95, 0.77-1.17, p = 0.621) or sepsis (0.98, 0.85-1.12, p = 0.748).

View Article: PubMed Central - PubMed

Affiliation: Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, Lyon, Rhône, France; Université Claude Bernard Lyon 1, Faculté de médecine Lyon Est, Lyon, Rhône, France.

ABSTRACT

Background: Mass tourism during winter in mountain areas may cause significant clustering of body injuries leading to increasing emergency admissions at hospital. We aimed at assessing if surgical safety and efficiency was maintained in this particular context.

Methods: We selected all emergency admissions of open surgery performed in French hospitals between 2010 and 2012. After identifying mountain areas with increasing volume of surgical stays during winter, we considered seasonal variations in surgical outcomes using a difference-in-differences study design. We computed multilevel regressions to evaluate whether significant increase in emergency cases had an effect on surgical mortality, complications and length of stay. Clustering effect of patients within hospitals was integrated in analysis and surgical outcomes were adjusted for both patient and hospital characteristics.

Results: A total of 381 hospitals had 559,052 inpatient stays related to emergency open surgery over 3 years. Compared to other geographical areas, a significant peak of activity was noted during winter in mountainous hospitals (Alps, Pyrenees, Vosges), ranging 6-77% volume increase. Peak was mainly explained by tourists' influx (+124.5%, 4,351/3,496) and increased need for orthopaedic procedures (+36.8%, 4,731/12,873). After controlling for potential confounders, patients did not experience increased risk for postoperative death (ratio of OR 1.01, 95%CI 0.89-1.14, p = 0.891), thromboembolism (0.95, 0.77-1.17, p = 0.621) or sepsis (0.98, 0.85-1.12, p = 0.748). Length of stay was unaltered (1.00, 0.99-1.02, p = 0.716).

Conclusion: Surgical outcomes are not compromised during winter in French mountain areas despite a substantial influx of major emergencies.

No MeSH data available.


Related in: MedlinePlus