Patient Safety, Post-Operative Monitoring

8 Surprising Facts From a 7 Day Cohort Study: Mortality After Surgery

By Sean Power
October 16, 2014

A recent article in The Lancet published findings that suggest mortality after non-cardiac surgery in Europe may be higher than expected.

Dr. Rupert Pearse and a team of researchers conducted the European Surgical Outcomes Study (EuSOS)—a study that spanned 28 European countries and included 498 hospitals—in an attempt to describe mortality after non cardiac surgery at a national and international level.

Heterogeneity between hospitals suggests potential to improve care for patients—in particular, high risk surgical patients who are appropriate for post op ICU admission. It also makes it difficult to describe clinical outcome improvement at the national and international level. This difficulty in the actual potential to improve care remained unconfirmed and provided impetus for the EuSOS Study.

Assessing outcomes after non-cardiac surgery, EuSOS conducted a seven-day cohort study between April 4 and April 11, 2011. Researchers collected data describing consecutive patients aged 16 and older undergoing inpatient non-cardiac surgery.

EuSOS Study Figure 2

The researchers looked at in-hospital mortality, duration of hospital stay, and admission to critical care in its assessment of clinical outcomes. They found that mortality rate for inpatient non-cardiac surgery was higher than expected, at 4 percent.

“Variations in mortality between countries suggest the need for national and international strategies to improve care for this group of patients,” say the authors.

Contained within the article are eight facts about non-cardiac surgery that may surprise you:

  1. More than 230 million major surgical procedures are undertaken worldwide each year.
  2. Ten percent of patients undergoing surgery in the UK are high risk and account for 80 percent of the country’s postoperative deaths.
  3. Up to 25 million patients undergo high risk surgical procedures each year, of whom, 3 million do not survive until discharge.
  4. The EuSOS Study, which provided a data population of more than 46,000 unselected patients undergoing inpatient surgery from 28 European countries, revealed mortality rate of 4 percent for non-cardiac inpatient surgery patients.
  5. Cultural, demographic, socioeconomic, and political differences might affect population health and health care outcomes. Countries such as Ireland, Latvia, Poland, and Romania all had higher mortality rates than countries such as Finland, France, Germany, and the UK.
  6. In the EuSOS Study, unplanned admissions to critical care were associated with higher mortality rates than were planned admissions.
  7. Most patients who died (73 percent) were not admitted to critical care at any stage after surgery; of patients who died after admission to critical care, 43 percent did so after the initial episode was complete and the patient had been discharged to a standard ward. This may indicate insufficient acute care post operative monitoring or staff whose skill set cannot early on detect onset of possible adverse event or deterioration from baseline status.
  8. Patients who develop complications but survive to leave the hospital often have reduced functional independence capacity and long-term survival, which cause a poorer quality of life than those that do not develop complications.

According to the authors, the findings may indicate a “systematic failure in the process of allocation of critical care resources”, saying that the study suggests both the need and potential to implement measures to improve postoperative outcomes.

EuSOS Table 2

The authors conclude that the quality of perioperative care is likely to be among the most important reasons why outcomes for cardiac and non-cardiac surgical patients differ. They point towards preoperative assessment, optimization of coexisting medical disease, WHO surgical checklists, advanced haemodynamic monitoring during surgery, early admission to critical care, acute pain management, and hospital discharge planning as possible areas for improvement.

Are you involved in non-cardiac surgeries at a hospital? Tell us what you think of the EuSOS Study.

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