Mortality after surgery in Europe:A 7 day cohort study

• Published in: The Lancet
• Format: Article in Journal/Newspaper
• Language: English
• Published: 2012
• Subjects: Iceland
• Online Access: https://pure.au.dk/portal/da/publications/mortality-after-surgery-in-europe(b7e84737-4520-4f3f-9608-12de7f54e340).html; https://doi.org/10.1016/S0140-6736(12)61148-9; http://www.scopus.com/inward/record.url?scp=84866510395&partnerID=8YFLogxK

Background 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. Methods 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. Findings 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). Interpretation The mortality rate for patients undergoing inpatient non-cardiac surgery was higher than anticipated. Variations in mortality between countries suggest the need for national and international strategies to improve care for this group of ...