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Objective: To compare mortality outcomes in the three years after elective colectomy, no colectomy, and emergency colectomy among people admitted to hospital for inflammatory bowel disease, to inform whether the threshold for elective colectomy in clinical practice is appropriate., Design: Record linkage studies., Setting: Oxford region (1968-99) and England (1998-2003)., Participants: 23,464 people with hospital stay for more than three days for inflammatory bowel disease, including 5480 who had colectomy., Main Outcome Measures: Case fatality, relative survival, and standardised mortality ratios., Results: In the Oxford region, three year mortality was lower after elective colectomy than after either no colectomy or emergency colectomy, although this was not significant. For England, mortality three years after elective colectomy for ulcerative colitis (3.7%) and Crohn's disease (3.3%) was significantly lower than that after either admission without colectomy (13.6% and 10.1%; both P<0.001) or emergency colectomy (13.2% and 9.9%; P<0.001 for colitis and P<0.01 for Crohn's disease). Three or more months after elective colectomy, mortality was similar to that in the general population. Adjustment for comorbidity did not affect the findings., Conclusions: In England, the clinical threshold for elective colectomy in people with inflammatory bowel disease may be too high. Further research is now required to establish the threshold criteria and optimal timing of elective surgery for people with poorly controlled inflammatory bowel disease.

Objectives: To investigate trends in the incidence of acute pancreatitis resulting in admission to hospital, and mortality after admission, from 1963 to 1998., Design: Analysis of hospital inpatient statistics for acute pancreatitis, linked to data from death certificates., Setting: Southern England., Subjects: 5312 people admitted to hospital with acute pancreatitis., Main Outcome Measures: Incidence rates for admission to hospital, case fatality rates at 0-29 and 30-364 days after admission, and standardised mortality ratios at monthly intervals up to one year after admission., Results: The incidence of acute pancreatitis with admission to hospital increased from 1963-98: age standardised incidence rates were 4.9 per 100,000 population in 1963-74, 7.7 in 1975-86, and 9.8 in 1987-98. Age standardised case fatality rates within 30 days of admission were 14.2% in 1963-74, 7.6% in 1975-86, and 6.7% in 1987-98. From 1975-98, standardised mortality ratios at 30 days were 30 in men and 31 in women (compared with the general population of equivalent age in the same period = 1), and they remained significantly increased until month 5 for men and month 6 for women., Conclusions: Incidence rates for acute pancreatitis with admission to hospital rose in both men and women from 1963 to 1998, particularly among younger age groups. This probably reflects, at least in part, an increase in alcoholic pancreatitis. Mortality after admission has not declined since the 1970s. This presumably reflects the fact that no major innovations in the treatment of acute pancreatitis have been introduced. Pancreatitis remains a disease with a poor prognosis during the acute phase.

Objectives: To investigate time trends in mortality after admission to hospital for fractured neck of femur from 1968 to 1998, and to report on the effects of demographic factors on mortality., Design: Analysis of hospital inpatient statistics for fractured neck of femur, incorporating linkage to death certificates., Setting: Four counties in southern England., Subjects: 32 590 people aged 65 years or over admitted to hospital with fractured neck of femur between 1968 and 1998., Main Outcome Measures: Case fatality rates at 30, 90, and 365 days after admission, and standardised mortality ratios at monthly intervals up to one year after admission., Results: Case fatality rates declined between the 1960s and the early 1980s, but there was no appreciable fall thereafter. They increased sharply with increasing age: for example, fatality rates at 30 days in 1984-98 increased from 4% in men aged 64-69 years to 31% in those aged > or = 90. They were higher in men than women, and in social classes IV and V than in classes I and II. In the first month after fracture, standardised mortality ratios in women were 16 times higher, and those in men 12 times higher, than mortality in the same age group in the general population., Conclusions: The high mortality rates, and the fact that they have not fallen over the past 20 years, reinforce the need for measures to prevent osteoporosis and falls and their consequences in elderly people. Whether post-fracture mortality has fallen to an irreducible minimum, or whether further decline is possible, is unclear.