Mortality after surgery in Europe: A 7 day cohort study

• Published in: The Lancet
• Main Authors: Pearse, R, Moreno, R, Bauer, P, Pelosi, P, Metnitz, P, Spies, C, Vallet, B, Vincent, J, Hoeft, A, Rhodes, A, Fagnoul, D, van Obbergh, L, Al Subaie, N, Arif, F, Cashman, J, Cecconi, M, Edsell, M, Fossati, N, Hammond, S, Hamilton, M, Lonsdale, D, Moran, C, Siegmueller, C, Velzeboer, F, Wong, P, Awlakpui, E, Scheidemann, M, Wittmann, M, Damster, S, Golder, K, Hewson, R, Januszewska, M, Leva, B, Ramos, V, Hoste, E, Huyghens, L, Jacobs, R, Van Mossevelde, V, Opdenacker, G, Poelaert, J, Spapen, H, Leleu, K, Rijckaert, D, De Decker, K, Foubert, L, De Neve, N, Biston, P, Piagnerelli, M, Collin, V, den Blauwen, N, Clauwaert, C, De Crop, L, Verbeke, A, Derumeaux, P, Gardin, C, Kindt, S, Louage, S, Verhamme, B, Druwé, P, Lahaye, I, Rosseel, F, Rutsaert, R, Vanlinthout, L, De Kock, M, Forget, P, Georges, P, Grosu, I, Kahn, D, Lois, F, Momeni, M, Pospiech, A, Yemnga, B, Jadoul, J, Malbrain, M, Bosinceanu, D, Collard, E, Jorens, P, Reyntiens, D, Smitz, C, Vercauteren, M, Goranović, T, Mazul Sunko, B, Toplice, K, Oremuš, K, Bešlić, G, Duzel, V, Hauptman, A, Peremin, S, Šribar, A, Župčić, M, Brod, S, Mirković, I, Šarić Bauer, Z, Belavić, M, Blažanin, B, Katušin, M, Brozović Krijan, A, Mišković, P, Šimić Korać, N, Topić, J, Žilić, A, Žuni, J, Acan, I, Adanić, M, Ivanov, N, Pavičić Šarić, J, Tomulić, K, Visković, N, Bošnjak, S, Haršanji Drenjančevic, I, Kristek, G, Kvolik, S, Markić, S, Stojanovic Rakipovic, A, Katarina Tot, O, Venzera Azenic, D, Kalagac Fabris, L, Bačak Kocman, I, Balenović, I, Bandić, D, Judith Deutsch, P, Divjak, L, Filipović, I, Gužvinec, Z, Krznarić, Z, Lončarić, Y, Magaš, J, Mitrović, M, Okić, M, Pavlek, M, Ramov, E, Rezek, K, Sekulić, A, Tomasevic, B, Mirić, M, Tomašević, A, Tomić Mahečić, T, Vrbanović, V, Bobinac, M, Božić, A, Debelic, D, Frkovic, V, Batinica, I, Baranović, S, Gavranović, Ž, Kikec, M, Maldini, B, Marić, S, Agnić, I, Delić, N, Dropulić, N, Kljaković Gašpić, T, Ilić, D, Ivančev, B, Karanović, N, Kuščević, D, Marović, Z, Milić, M, Nevešćanin, A, Petković, T, Smoje, M, Brozović, G, Jelisavac, M, Matolić, M, Oberhofer, D, Marija Pavičić, A, Šakić, K, Delija Bozovic, M, Kotorac Krecek, Z, Krobot, R, Andabaka, T, Bratanić, M, Dzepina, O, Kraljev, M, Šeric, J, Šimurina, T, Grujić, R, Nacevski Bulaja, B, Barižon, M, Danira, V, Dražen, B, Dušanka, K, Bašić Halužan, M, Joško, Ž, Katica, R, Labor, M, Grgurević Marinković, T, Mihovilčević, D, Marija, B, Srečko, M, Vranković, S, Kyprianou, T, Neophytou, K, Cerny, V, Cvachovec, K, Belikova, B, Drab, M, Hudacek, K, Krikava, I, Stourac, P, Zadrazilova, K, Bicek, V, Brabcová, M, Klozová, R, Vajter, J, Vymazal, T, Toft, P, Blichfeldt, L, Dilling Hansen, B, Moller, K, Sylvest Nielsen, J, Frederiksen, J, Dohn Andersen, J, Peter Kühne, J, Leivdal, S, Stendell, L, Simonsen, M, Konrad Zoltowski, M, Salman Ali, Z, Freundlich, M, Pilypaite, J, Groes Clausen, N, Thorup, L, Hansen, F, Bestle, M, Steen Hansen, C, Afshari, A, Bastholm Bille, A, Lefort, M, Secher, E, Liboriussen, L, Herodes, V, Härma, E, Marvet, K, Pool, K, Kallas, P, Mägi, T, Sütt, J, Vijar, K, Visk, E, Vinnal, M, Ellermaa, J, Liibusk, L, Tikkerberi, A, Falk, I, Mällo, E, Talving, J, Pettilä, V, Hovilehto, S, Kirsi, A, Mustola, S, Tiainen, P, Toivonen, J, Dabnell, S, Kaminski, T, Sysimetsa, A, Kaukonen, M, Silvasti, P, Vainio, K, Lund, V, Sjövall, S, Saarinen, K, Viitanen, M, Ahonen, T, Alaspää, A, Zittling, R, Saarinen, A, Moisander, A, Wagner, B, Laru Sompa, R, Elomaa, E, Lavonen, L, Nevantaus, J, Geier, K, Kavasmaa, T, Koorits, U, Kubjas, M, Lauritsalo, S, Ottelin, L, Palve, M, Pynnönen, J, Rääbis, I, Saarelainen, M, Heikkilä, T, Kontula, T, Lehtimäki, M, Liimatainen, J, Moilanen Oikarinen, M, Pakarinen, M, Palanne, R, Seppänen, H, Pulkkinen, A, Vääräniemi, H, Koskenkari, J, Sälkiö, S, Vakkala, M, Koskue, T, Loisa, P, Laitio, R, Hautamäki, R, Koivisto, S, Futier, E, Lefrant, J, Leon, A, Bonnet, F, Marret, E, Spielvogel, C, Papageorgiou, C, Szymkiewicz, O, Tounou Akue, F, Aubrun, F, Bonnet, A, Gazon, M, Guiraud, M, Laurent, V, Tachon, G, Demars, N, Dumenil, A, Mercier, F, Landais, A, Mentec, H, Bazin, M, Gonnu, S, Petit, A, Albaladejo, P, Almeras, L, Bataillard, A, Rossi Blancher, M, Yves Lefrant, J, Barthel, F, Hallel, D, Sbai, H, Khalifeh, P, Lidzborski, L, Jully, M, Platon, E, Pottecher, J, Baumgarten, R, Schultz, C, Elmiloudi, F, Lefebvre, J, Waton, K, Sprunck, A, Steib, A, Thibaud, A, Thuet, V, Kieffer, V, Dubois Vallaud, D, Jacob, L, Becanne, X, Cherfaoui, S, Gauzit, R, Godier, A, Lakhdari, M, Samma, C, Bigeon, J, Burtin, P, Halchini, C, Lacroix, M, Pinna, F, Barbes, A, Just, B, Mateu, P, Benayoun, L, Berger, P, Granier, N, Francois Perrigault, P, Libert, N, De Rudnicki, S, Merat, S, Bourdet, B, Ferré, F, Minville, V, Piriou, V, Rague, P, Wallet, F, Lebuffe, G, Desbordes, J, Robin, E, Ichai, C, Orban, J, Marx, G, Sander, M, Gottschalk, A, Piontek, A, Unterberg, M, Hilpert, J, Kees, M, Triltsch, A, Wiegand Löhnert, C, Glöckner, C, Hohn, A, Rose, E, Schröder, S, Wiese, O, Ramminger, A, Dresden, C, de Abreu, M, Heller, A, Marx, C, Neidel, J, Goldmann, A, von Heymann, C, Laetsch, B, Maahs, E, Scholz, L, Frenzel, D, Massarat, K, Lenhart, F, Reichle, F, Rudlof, K, Borchers, F, Buettner, C, Schmutzler, M, Burgard, G, Lucht, A, Wagner, J, Pilge, S, Schneider, G, Untergehrer, G, Bis, B, Krassler, J, Dittmann, J, Haberkorn, J, Eberitsch, J, Eberitsch, K, Nippraschk, T, Wepler, U, Engelen, W, Nau, C, Scholler, A, Schüttler, J, Wintzheimer, S, Bloos, F, Braune, A, Fergen, D, Ludewig, K, Paxian, M, Reinhart, K, Graf, N, Schwarzkopf, K, Berger, K, Habicher, M, Kasperiunaite, R, Savelsberg, S, Krep, H, Reindl, M, Weber, M, Bauer, W, Bingold, F, Christ, S, Friederich, P, Kaviani, R, Auer, P, Bonnländer, G, Drescher, J, Braun, R, Eichenauer, T, Kerner, J, Bierbaum, K, Brünner, H, Grond, S, Perez Platz, U, Andresen, B, Linstedt, U, Stegmann, N, Erkens, U, Kopcke, J, Meyer, A, Brestrich, H, Ernst, S, Merkel, S, Krieger, L, Luers, F, Weyland, A, Noeldge Schomburg, G, Menckie, T, Wasmund, C, Bredtmann, R, Erler, I, Raufhake, C, Haumann, C, Möllemann, A, Oehmichen, U, Sergejewa, O, Lehning, B, Czeslick, E, Geyer, M, Malcharek, M, Sablotzki, A, Stier, M, Feld, F, Rossaint, R, Simon, V, Armaganidis, A, Koulenti, D, Kotanidou, A, Nanas, S, Papastylianou, A, Psevdi, A, Stathopoulos, A, Voulas, A, Kanna, E, Koutsikou, A, Moustaka, A, Chovas, A, Komnos, A, Zafiridis, T, Franses, J, Lavrentieva, A, Koraki, E, Katsenos, C, Flora Kasianidou, M, Nasopoulou, P, Spyropoulou, E, Gousia, C, Katsanoulas, C, Lathyris, D, Kyriazopoulos, G, Sfyras, D, Tsirogianni, A, Kostopanagiotou, G, Lignos, M, Matsota, P, Christopoulos, C, Mouratidou, A, Vrettou, E, Boufidis, S, Moka, E, Arnaoutoglou, E, Koulouras, V, Nakos, G, Papathanakos, G, Anthopoulos, G, Choutas, G, Karapanos, D, Tzani, V, Gkiokas, G, Nastos, K, Nikolakopoulos, F, Dragoumanis, C, Nikitidis, N, Pneumatikos, I, Theodorou, V, Zacharouli, D, Kandi, S, Tasopoulos, K, Arvaniti, K, Matamis, D, Mplougoura, E, Petropoulou, P, Soumpasis, I, Amaniti, E, Giannakou Peftoulidou, M, Gkeka, E, Soultati, I, Kokinou, M, Papatheodorou, L, Stafylaraki, M, Giasnetsova, T, Gritsi Gerogianni, N, Kydona, C, Kiskira, O, Koulentis, I, Apsokardos, A, Dimitropoulos, K, Soldatou, O, Nathanail, C, Papazotos, A, Tsakas, P, Clouva Molyvdas, P, Kolotoura, A, Sartzi, M, Papanikolaou, S, Polakis, P, Karatzas, S, Kyparissi, A, Papavasilopoulou, T, Koukoubani, T, Mastora, E, Spyropoulou Pagdatoglou, K, Nyktari, V, Malliotakis, P, Papaioannou, A, Bekos, V, Maragkou, E, Spring, A, Evagelatos, S, Ioakeimidou, A, Noulas, N, Molnár, Z, Csüllög, E, Elekes, E, Molnár, T, Katona, Z, Kremer, I, Miko, A, Csomos, A, Galambos, Z, Szucs, A, Nyikos, G, Szekeres, G, Szabo, E, Kranitz, K, Simon, M, Szigeti, J, Gaál, E, Havas, A, Ille, A, Bráz, K, Nagy, G, Sigurdsson, G, Sigurbjörnsson, F, Kárason, S, Edda Sigurdardottir, E, Blöndal, Á, Gunnarsson, B, Westbrook, A, Broderick, A, Hafeez, P, Hanumanthaiah, D, Brohan, J, O'Chroinin, D, Bailey, K, Ramamoorthy, K, Doyle, Y, Freir, N, O'Rourke, J, Jonson, P, Saeed, S, Hayes, I, Loughrey, J, Frohlich, S, Mccauley, N, Ryan, D, Fitzpatrick, G, Kevin, L, Thomas, J, Warde, B, Woolhead, A, Duggan, M, Egan, C, Crowley, S, Lebese, S, Bergin, A, Page, R, Collins, D, Mckenny, M, Della Rocca, G, Grasso, S, Bresciani, A, Carmino, L, Ghelfi, S, Lorenzelli, L, Teresa Novelli, M, Pescarmona, C, Roasio, A, Gatta, A, Nastasi, M, Sanseverino, M, Tinti, C, Bianchin, A, Tormena, M, Franco, A, Marini, F, Di Mauro, P, Rapido, F, Tommasino, C, Bellotti, F, Boninsegna, D, Castellani, G, Sances, D, Spano, G, Tredici, S, Vezzoli, D, Fucecchio, I, Bacci, A, Coppini, R, Dell'Unto, S, Mori, E, Rosa Stanzani, M, Tosi, M, Collareta, M, Forfori, F, Franchi, M, Mancino, G, Battistella, M, Baricocchi, E, Bona, F, Debernardi, F, Giacoletto, G, Iacobellis, A, Massucco, P, Moselli, N, Muratore, A, Palomba, G, Sardo, E, De Simone, M, Suita, L, Zocca, E, Bucci, B, Della Corte, F, Piciucco, T, Viarengo, V, Bettelli, G, Cantarini, E, Giampieri, M, Tanfani, A, Recchia, E, Bignami, E, Bruno, G, Costagliola, R, Gandolfi, A, Greco, M, Lembo, R, Monti, G, Nicelli, E, Pasculli, N, Turi, S, Baroselli, A, Brazzoni, M, Buttazzoni, M, Buttera, S, Centonze, C, Serena, G, Spagnesi, L, Toretti, I, Vilardi, A, Zearo, E, Arpino, I, Baraldi, S, Guarnerio, C, Molene, V, Concetta Monea, M, Vaccarisi, E, Vicari, L, Albante, A, Aversano, M, Loiacono, C, Marandola, M, Fusari, M, Petrucci, N, Galla, A, Mascia, A, Primieri, P, Di Noto, A, Gratarola, A, Molin, A, Spagnolo, L, Spena, C, Calligaro, P, Marchiotto, S, Merlini, A, Pedrazzoli, E, Perina, G, Visentin, R, Garbagnati, A, Manetti, B, Snaier, C, Somaini, M, Farnia, A, Nani, R, Pierantonio, N, De Michele, M, Gazzanelli, S, Pugliese, F, Ruberto, F, Bergamini, E, Tassinati, T, Capuzzo, M, Cirillo, V, Tufano, R, Oggioni, R, Parrini, V, Brunori, E, Capone, M, Carbone, L, Corradetti, F, Elisei, D, Fiorentino, S, Francesconi, M, Gattari, D, Gorgoglione, M, Lacobone, E, Minnucci, F, Montironi, C, Riccioni, G, Tappata, G, Zompanti, V, Verdenelli, P, Cerutti, E, Marco Ranieri, V, Golubovska, I, Grigorjevs, S, Rikmane, M, Rozkalne, D, Stepanovs, J, Suba, O, Kazune, S, Miscuk, A, Nemme, J, Oss, P, Sipylaite, J, Macas, A, Ragaisis, V, Kontrimaviciute, E, Tomkute, G, Boerma, C, Fleur Kramer, I, Poeze, M, Maria, J, Pelzer, G, Winsser, L, Nijsten, M, Schoorl, M, Spanjersberg, R, Buhre, W, Dieleman, S, van Klei, W, Bouw, M, Pickkers, P, van der Marieke, A, Schreiner, F, Zandvliet, R, van den Berg, R, De Wit, E, Keijzer, C, Hollmann, M, Preckel, B, van Acker, G, Dennesen, P, Veld, B, Kuijpers Visser, A, Inan, T, Koopman van Gemert, A, Ponssen, H, Brouwer, T, Koopmans, M, van Bommel, J, van Duijn, D, van der Hoven, B, Ormskerk, P, Beck, O, Schiere, S, Reidinga, A, Venema, A, Hoogendoorn, M, Olthof, K, Flaatten, H, Jammer, I, Dokka, V, Arne Monsen, S, Marius Ytrebo, L, Noursadeghi, M, Shahzad, A, Dagfinn Boksasp, O, Roiss, C, Frank Strietzel, H, Gina, A, Berntsen, S, Haugland, H, Ove Vingsnes, S, Axelsson, P, Risom Olsen, T, Katre, S, Aakeroey, K, Mikstacki, A, Tamowicz, B, Boziłow, D, Goch, R, Grabowski, P, Kupisiak, J, Małłek, M, Szyca, R, Kostyrka, W, Choma, R, Jankowski, G, Kościelniak, W, Pietraszek, P, Szarowar, B, Matos, R, França, C, Pais Lacerda, A, Ormonde, L, Rosa, R, Pereira, I, Vitor, P, Completo Bento, H, Raquel Lopes, M, Carvalho, M, Faria, M, Cláudia de Sousa, A, de Freitas, P, Almeida, E, Mealha, R, Vicente, R, Monte, R, Rua, F, Barros, N, Esteves, F, Gouveia Pinheiro, C, Real, V, Miguel Oliveira, V, Fátima Oliveira, M, Martins, I, Pedro Saraiva, J, Pedro Assunção, J, Bártolo, A, Carvalho, A, Correia, C, Martins, S, Milheiro, R, Diaz, A, Imelda Gonçalves, M, Ribeiro, R, Estilita, J, Glória, C, de Almeida, J, Barros, F, Ramos, A, Camara, M, Richard Maul, E, Nobrega, J, Langner, A, Faria Maia, D, Afonso, O, Faria, F, Serra, S, Manuela Botelho, M, Ferreira, P, Mourão, L, Vintém Oliveira, A, Resende, M, Aleman, M, Fonseca, J, Isidoro, M, de Meneses, H, Pêgas, A, Pereira, J, Pereira, L, Ramos, B, Matos, F, Gonçalves Castro, M, Martins, A, Ramos, C, de Sousa, M, Bento, L, Botas, C, Lopes, V, Mendes, R, Grigoras, I, Blaj, M, Damian, M, Lupusoru, A, Ristescu, I, Codreanu, M, Diaconescu, C, Nistor, A, Stanescu Stelian, D, Streanga, L, Berneanu, M, Bordeianu, C, Florenta, C, Iacob, A, Nicoleta Lupu, M, Mocanu, I, Moraru, C, Meran, C, Nicolae, B, Sandu, M, Turcanu, R, Epure, F, Grigore, M, Hotaranu, C, Popescu, N, Baban, O, Baciu, M, Ciobanu, A, Ioan Denciu, C, Gurau, V, Maftei, I, Moldovan, I, Ungureanu, L, Bogdan, P, Corneci, D, Dinu, M, Madalina, D, Rely, M, Silvius, N, Tomescu, D, Gabriela, D, Adrian Dinescu, S, Calin, M, Ionescu, D, Margarit, S, Vasian, H, Albu, C, Balasa, C, Cadrigati, A, Dragulescu, D
• Format: Article in Journal/Newspaper
• Language: English
• Published: Lancet Publishing Group 2012
• Subjects: Adult; Aged; Cohort Studie; Critical Care; Europe; Female; Hospital Mortality; Hospitalization; Human; Length of Stay; Male; Middle Aged; Postoperative Care; Surgical Procedures; Operative; Treatment Outcome; Medicine (all); Iceland
• Online Access: http://hdl.handle.net/10281/75041; https://doi.org/10.1016/S0140-6736(12)61148-9; http://www.journals.elsevier.com/the-lancet/

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 χ2 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 ...