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Patients aged over 18 undergoing laparotomy for any surgical indication through any major incision in both elective and emergency settings were eligible for enrolment. Randomisation was performed when the patient was in the anaesthetic room immediately before surgery by using a secure online system provided by the University of Birmingham. To help match the two arms, randomisation was stratified according to the urgency of surgery, likelihood of opening a viscus, and likelihood of creating a stoma, with the use of a minimisation procedure. The in theatre surgical team were aware of arm allocation but only after induction of anaesthesia. No information about arm allocation was recorded in the clinical or operation notes, and the patient, ward staff, and clinicians undertaking the reviews of postoperative wounds were fully blinded to the group assignments.

T H C Stevenson in 1911, with the introduction of the registrar general’s social classes, began a remarkable series of publications, continuing for a century, of “social class” inequalities in health. In 1980, the Black report summarised this evidence, gave an explanatory framework, and made recommendations.1 At the time of Black, observers from many countries scoffed at this health manifestation of the British class system. Cheap Levitra Australia
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countries there were socioeconomic inequalities in health of the same order as those found in the UK. Subsequent research has confirmed that all countries have inequalities in health, although the magnitude varies.2 3 The UK led the world, not in having the most striking differences in health between social classes, but in having the best data and, based on this evidence, in developing policies to combat health inequalities.

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