Europe-wide study finds death rates after surgery double that of recent estimates

September 20, 2012

National estimates of death following general surgery have been too optimistic, suggests the first large-scale study to explore surgical outcomes across Europe published in the first Article in a special Lancet theme issue on surgery. New estimates generated using a snap-shot of death after surgery in over 46 000 patients from 500 hospitals in 28 European countries indicate that overall crude mortality (death from all causes) is 4%, which is more than double previous estimates.

The overall picture shows that mortality rates vary widely between countries, from 1.2% in Iceland to 21.5% in Latvia. In the UK, the mortality rate was 3.6%, well above the highest previous estimates of 1.

What is more, says Rupert Pearse from Queen Mary, University of London who led the research, "Nearly three-quarters of patients who died were never admitted to intensive care. Failure to allocate critical care resources to patients at greatest risk of death is a serious public health concern for patients undergoing surgery in Europe."

The European Study (EuSOS) measured national in-hospital mortality and examined the allocation of critical care resources during 7 days in April, 2011. (aged 16 years or older) who underwent various non-cardiac procedures in participating centres were enrolled and tracked for up to 60 days after surgery.

Even after adjusting for possible confounding variables (eg, urgency and surgical procedure, age, and presence of metastatic disease) substantial differences in remained between nations. Compared with the UK (the country with the largest dataset), patients in Poland (OR: 6.92), Latvia (OR: 4.98), and Romania (OR: 3.19) had the greatest odds of dying. Within western Europe, patients in Ireland (OR: 2.61), Italy (OR: 1.70), Belgium (1.65), Portugal (1.43), and France (1.36) had a higher risk of dying.

The researchers note that the high mortality they identified across Europe contrasts with the 2% for patients who are routinely admitted to critical care. They speculate that the provision and use of beds may play a vital role in improving survival in patients undergoing non-.

According to Pearse, "The substantial variations in mortality between countries highlight the urgent need for national and international strategies to improve care for this group of patients."

In a linked Comment, René Vonlanthen and Pierre-Alain Clavien from University Hospital Zurich in Switzerland write, "In future studies, we need to learn more about the relevant issues and optimum processes to secure quality [assurance in surgery]. Targets could include the type of intensive care beds needed, volume, university versus community hospitals, and surgeons' qualifications. Costs for the overall postoperative course would also be key, to allow us to propose cost-effective and relevant corrective measures."

Explore further: Body mass index associated with short-term mortality rates following surgery

More information: www.thelancet.com/journals/lan … (12)61148-9/abstract

Related Stories

Body mass index associated with short-term mortality rates following surgery

November 21, 2011
Body Mass Index (BMI) appears to be associated with 30-day mortality risk following surgical procedures, and patients with a BMI of less than 23.1 appear to be at highest risk of death, according to a report published Online ...

Tight blood sugar control for pediatric cardiac surgery patients does not improve outcomes

September 10, 2012
Tight blood sugar control in the intensive care unit for pediatric cardiac surgery patients does not improve patients' infection rate, mortality, length of stay or organ failure when compared to standard care, new research ...

Joint replacement surgery riskier at hospitals with low surgical volume

June 7, 2011
Patients who undergo elective total hip or total knee arthroplasty at hospitals with lower surgical volume had a higher risk of venous thromboembolism and mortality following the procedure. The complications following joint ...

Do-not-resuscitate orders associated with poor surgical outcomes even for non-emergency procedures

April 18, 2011
Surgical patients with do-not-resuscitate (DNR) orders appear to be at higher risk for poor surgical outcomes, according to a report published online today by the Archives of Surgery, one of the JAMA/Archives journals. The ...

Variation in bowel reoperation rates prompts call for better quality measures

August 17, 2011
There is a large variation in unplanned reoperation rates after colorectal surgery in English NHS hospitals, finds a study published in the British Medical Journal today.

Recommended for you

Smoking raises risk of aneurysm recurrence after endovascular treatment

August 17, 2017
In a new study, researchers report people who have experienced an aneurysm have another reason to quit smoking.

Study adds to evidence that most prescribed opioid pills go unused

August 2, 2017
In a review of half a dozen published studies in which patients self-reported use of opioids prescribed to them after surgery, researchers at Johns Hopkins report that a substantial majority of patients used only some or ...

Engineers harness the power of 3-D printing to help train surgeons, shorten surgery times

August 2, 2017
A team of engineers and pediatric orthopedic surgeons are using 3D printing to help train surgeons and shorten surgeries for the most common hip disorder found in children ages 9 to 16. In a recent study, researchers showed ...

World's first child hand transplant a 'success'

July 19, 2017
The first child in the world to undergo a double hand transplant is now able to write, feed and dress himself, doctors said Tuesday, declaring the ground-breaking operation a success after 18 months.

Knee surgery—have we been doing it wrong?

July 18, 2017
A team of University at Buffalo medical doctors have published a study that challenges a surgical practice used for decades during arthroscopic knee surgery.

New tools help surgeons find liver tumors, not nick blood vessels

July 17, 2017
The liver is a particularly squishy, slippery organ, prone to shifting both deadly tumors and life-preserving blood vessels by inches between the time they're discovered on a CT scan and when the patient is lying on an operating ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.