Evidence map›Paper›PMID 41478799›Full record

Observational studyBritish journal of anaesthesia2026

Factors associated with admission before the day of elective major surgery: an analysis of data from the UK Perioperative Quality Improvement Programme.

Bo Hou, Tom Salih, James Bedford, Adam Hunt, Duncan Wagstaff, Arun Sahni, Eleanor Warwick, PQIP delivery team, Suneetha Ramani Moonesinghe, PQIP Collaborative

Abstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in British journal of anaesthesia, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
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1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Bo HouNational Institute for Health Research Central London Patient Safety Research Collaboration (PSRC), University College London Hospitals NHS Foundation Trust, London, UK; Research Department of Targeted Intervention, Division of Surgery and Interventional Science, University College London, London, UK.
Tom SalihResearch Department of Targeted Intervention, Division of Surgery and Interventional Science, University College London, London, UK; Department of Anaesthesia and Perioperative Medicine, University College London Hospitals NHS Foundation Trust, London, UK.
James BedfordNational Institute for Health Research Central London Patient Safety Research Collaboration (PSRC), University College London Hospitals NHS Foundation Trust, London, UK; Research Department of Targeted Intervention, Division of Surgery and Interventional Science, University College London, London, UK; Department of Anaesthesia and Perioperative Medicine, University College London Hospitals NHS Foundation Trust, London, UK.
Adam HuntNational Institute for Health Research Central London Patient Safety Research Collaboration (PSRC), University College London Hospitals NHS Foundation Trust, London, UK; Research Department of Targeted Intervention, Division of Surgery and Interventional Science, University College London, London, UK; Department of Anaesthesia and Perioperative Medicine, University College London Hospitals NHS Foundation Trust, London, UK; Centre for Research and Improvement, Royal College of Anaesthetists, London, UK.
Duncan WagstaffNational Institute for Health Research Central London Patient Safety Research Collaboration (PSRC), University College London Hospitals NHS Foundation Trust, London, UK; Research Department of Targeted Intervention, Division of Surgery and Interventional Science, University College London, London, UK; Department of Anaesthesia and Perioperative Medicine, University College London Hospitals NHS Foundation Trust, London, UK.
Arun SahniDepartment of Anaesthesia and Perioperative Medicine, Broomfield Hospital, Mid and South Essex NHS Trust, Chelmsford, UK.
Eleanor WarwickDepartment of Anaesthesia and Perioperative Medicine, Kings College Hospital NHS Foundation Trust, London, UK.
PQIP delivery team
Suneetha Ramani MoonesingheNational Institute for Health Research Central London Patient Safety Research Collaboration (PSRC), University College London Hospitals NHS Foundation Trust, London, UK; Research Department of Targeted Intervention, Division of Surgery and Interventional Science, University College London, London, UK; Department of Anaesthesia and Perioperative Medicine, University College London Hospitals NHS Foundation Trust, London, UK. Electronic address: ramani.moonesinghe@nhs.net.
PQIP Collaborative

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundHospital capacity within the UK National Health Service is under unprecedented pressure. Reducing admission before the day of elective surgery might be an opportunity to reduce bed occupancy and improve patient flow, safety, and experience.

methodsThis was a secondary analysis of data from the UK Perioperative Quality Improvement Programme (PQIP), a prospective observational cohort study. Primary outcome was admission to hospital before the day of surgery, and secondary outcome was prolonged postoperative length of stay. We used mixed-effects multivariable regression modelling to evaluate associations with patient, case, and hospital characteristics.

resultsWe included 54 267 patients undergoing major elective surgery between December 2016 and February 2024, of whom 9124 (17%) were admitted before their surgical date. In adjusted analysis, predictors of early admission included increased straight-line distance from home to hospital (odds ratio 1.93, 95% confidence interval [1.59-2.35] for distance >64 km compared with <6 km), hypoalbuminaemia, anaemia, raised creatinine, poorly controlled diabetes mellitus, use of bowel preparation, failure to complete preassessment, and surgical specialty. Likelihood of early admission was clustered by hospital (intraclass correlation coefficient=0.527). Postoperative length of stay was associated with identifiable case-level factors that explained most of the observed variation (intraclass correlation coefficient=0.063).

conclusionsMultiple risk factors for admission before day of surgery could be addressed through policy or local quality improvement. Unexplained variation at the hospital level might reflect local culture and process, which should be explored in future research. We recommend exploring hotel-type accommodation as a potentially cost-effective alternative to preoperative inpatient admission for suitable patients.

Indexed as

Elective Surgical ProceduresPatient AdmissionQuality ImprovementAdultAgedCohort StudiesFemaleHumansLength of StayMaleMiddle AgedProspective StudiesUnited Kingdomday surgery admissionhospital capacityhospital length of stayNatioanl Health Servicepatient safetyPerioperative Quality Improvement Programme

Identifiers

PMID41478799
PMCPMC12975378

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.