Mortality after surgery in Europe: a 7 day cohort study

• Published in: The Lancet
• Main Authors: R. M. Pearse, RP Moreno, P. Bauer, P. Metnitz, C. Spies, B. Vallet, J. L. Vincent, A. Hoeft, A. Rhodes, PELOSI, PAOLO PASQUALINO
• Other Authors: R. M., Pearse, Rp, Moreno, P., Bauer, Pelosi, PAOLO PASQUALINO, P., Metnitz, C., Spie, B., Vallet, J. L., Vincent, A., Hoeft, A., Rhodes
• Format: Article in Journal/Newspaper
• Language: English
• Published: Elsevier 2012
• Subjects: Hospital admission; Hospital discharge; Intensive care; Length of stay; Surgical mortality; Iceland
• Online Access: http://hdl.handle.net/11567/656386; https://doi.org/10.1016/S0140-6736(12)61148-9

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 patients