Mortality after surgery in Europe: a 7 day cohort study
(2012) In The Lancet p.1059-1065- Abstract
- 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 unconfi rmed. 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 Europeannations. Patients were followed up for a maximum of 60 days. The primary endpoint was in-hospital mortality.Secondary outcome measures were... (More)
- 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 unconfi rmed. 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 Europeannations. 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’sexact tests to compare categorical variables and the t test or the Mann-Whitney U test to compare continuous variables.Signifi cance was set at p<0·05. We constructed multilevel logistic regression models to adjust for the diff erences inmortality 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 diff erences 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.Funding European Society of Intensive Care Medicine, European Society of Anaesthesiology. (Less)
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https://lup.lub.lu.se/record/e18be913-9b72-4123-906f-63a542e2a35d
- author
- Pearse, Rupert M ; Rhodes, Andrew and Klarin, Bengt LU
- contributor
- Adolfsson, Anne
; Chew, Michelle
LU
; Merisson, Edyta
LU
and Jawad, Monir
LU
- author collaboration
- publishing date
- 2012-09-22
- type
- Contribution to journal
- publication status
- published
- subject
- in
- The Lancet
- pages
- 1059 - 1065
- publisher
- Elsevier
- external identifiers
-
- scopus:84866510395
- ISSN
- 1474-547X
- DOI
- 10.1016/S0140-6736(12)61148-9
- language
- English
- LU publication?
- no
- id
- e18be913-9b72-4123-906f-63a542e2a35d
- date added to LUP
- 2021-02-08 01:51:52
- date last changed
- 2022-04-27 00:06:34
@article{e18be913-9b72-4123-906f-63a542e2a35d,
abstract = {{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 unconfi rmed. 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 Europeannations. 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’sexact tests to compare categorical variables and the t test or the Mann-Whitney U test to compare continuous variables.Signifi cance was set at p<0·05. We constructed multilevel logistic regression models to adjust for the diff erences inmortality 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 diff erences 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.Funding European Society of Intensive Care Medicine, European Society of Anaesthesiology.}},
author = {{Pearse, Rupert M and Rhodes, Andrew and Klarin, Bengt}},
issn = {{1474-547X}},
language = {{eng}},
month = {{09}},
pages = {{1059--1065}},
publisher = {{Elsevier}},
series = {{The Lancet}},
title = {{Mortality after surgery in Europe: a 7 day cohort study}},
url = {{http://dx.doi.org/10.1016/S0140-6736(12)61148-9}},
doi = {{10.1016/S0140-6736(12)61148-9}},
year = {{2012}},
}