Mortality after surgery in Europe: a 7 day cohort study.

• Published in: The Lancet
• Main Authors: Pearse, Rupert M, Moreno, Rui P, Bauer, Peter, Pelosi, Paolo, Metnitz, Philipp, Spies, Claudia, Vallet, Benoit, Vincent, Jean-Louis, Hoeft, Andreas, Rhodes, Andrew, Sigurdsson, GH, Karason, S, Sigurbjörnsson, FT, Sigurdardottir, EE
• Other Authors: Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
• Format: Article in Journal/Newspaper
• Language: English
• Published: Elsevier Science 2012
• Subjects: Adult; Aged; Cohort Studies; Critical Care; Europe; Female; Hospital Mortality; Hospitalization; Humans; Length of Stay; Male; Middle Aged; Postoperative Care; Surgical Procedures; Operative; Treatment Outcome; Iceland
• Online Access: http://hdl.handle.net/2336/301239; https://doi.org/10.1016/S0140-6736(12)61148-9

To access publisher's full text version of this article. Please click on the hyperlink in Additional Links field. Clinical outcomes after major surgery are poorly described at the national level. Evidence of heterogeneity between hospitals and health-care systems suggests potential to improve care for patients but this potential remains unconfirmed. The European Surgical Outcomes Study was an international study designed to assess outcomes after non-cardiac surgery in Europe. We did this 7 day cohort study between April 4 and April 11, 2011. We collected data describing consecutive patients aged 16 years and older undergoing inpatient non-cardiac surgery in 498 hospitals across 28 European nations. Patients were followed up for a maximum of 60 days. The primary endpoint was in-hospital mortality. Secondary outcome measures were duration of hospital stay and admission to critical care. We used χ(2) and Fisher's exact tests to compare categorical variables and the t test or the Mann-Whitney U test to compare continuous variables. Significance was set at p<0·05. We constructed multilevel logistic regression models to adjust for the differences in mortality rates between countries. We included 46,539 patients, of whom 1855 (4%) died before hospital discharge. 3599 (8%) patients were admitted to critical care after surgery with a median length of stay of 1·2 days (IQR 0·9-3·6). 1358 (73%) patients who died were not admitted to critical care at any stage after surgery. Crude mortality rates varied widely between countries (from 1·2% [95% CI 0·0-3·0] for Iceland to 21·5% [16·9-26·2] for Latvia). After adjustment for confounding variables, important differences remained between countries when compared with the UK, the country with the largest dataset (OR range from 0·44 [95% CI 0·19-1·05; p=0·06] for Finland to 6·92 [2·37-20·27; p=0·0004] for Poland). The mortality rate for patients undergoing inpatient non-cardiac surgery was higher than anticipated. Variations in mortality between countries suggest the need for ...