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Multicenter Study
. 2012 Sep 22;380(9847):1059-65.
doi: 10.1016/S0140-6736(12)61148-9.

Mortality after surgery in Europe: a 7 day cohort study

Rupert M Pearse  1 , Rui P Moreno, Peter Bauer, Paolo Pelosi, Philipp Metnitz, Claudia Spies, Benoit Vallet, Jean-Louis Vincent, Andreas Hoeft, Andrew Rhodes; European Surgical Outcomes Study (EuSOS) group for the Trials groups of the European Society of Intensive Care Medicine and the European Society of Anaesthesiology
Collaborators, Affiliations
Multicenter Study

Mortality after surgery in Europe: a 7 day cohort study

Rupert M Pearse et al. Lancet. .

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 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.

Funding: European Society of Intensive Care Medicine, European Society of Anaesthesiology.

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Figures

Figure 1
Figure 1
Study profile (A) All patients. (B) Patients admitted to critical care. CRF=case report form.
Figure 2
Figure 2
Planned and unplanned admission to a critical-care unit according to urgency of surgery Data are n (%) or median (IQR). We collected data describing the first critical care admission for any individual patient. The data presented do not describe readmission to critical care. Because of incomplete data for admission planning, 19 admissions to critical care are not presented in this figure. EuSOS=European Surgical Outcomes Study. Elective=not immediately life saving; planned within months or weeks. Urgent=planned surgery within hours or days of the decision to operate. Emergency=as soon as possible; no delay to plan care; ideally within 24 h.
Figure 3
Figure 3
Adjusted odds ratio for death in hospital after surgery for each country
See this image and copyright information in PMC

Comment in

  • What factors affect mortality after surgery?
    Vonlanthen R, Clavien PA. Vonlanthen R, et al. Lancet. 2012 Sep 22;380(9847):1034-6. doi: 10.1016/S0140-6736(12)61417-2. Lancet. 2012. PMID: 22998699 No abstract available.
  • Mortality after surgery in Europe.
    Franek E, Osinska B, Czech M, Figat J. Franek E, et al. Lancet. 2013 Feb 2;381(9864):369-70. doi: 10.1016/S0140-6736(13)60161-0. Lancet. 2013. PMID: 23374466 No abstract available.
  • Mortality after surgery in Europe.
    Mikstacki A. Mikstacki A. Lancet. 2013 Feb 2;381(9864):369. doi: 10.1016/S0140-6736(13)60160-9. Lancet. 2013. PMID: 23374467 No abstract available.
  • Mortality after surgery in Europe.
    Pupelis G, Vanags I. Pupelis G, et al. Lancet. 2013 Feb 2;381(9864):369. doi: 10.1016/S0140-6736(13)60159-2. Lancet. 2013. PMID: 23374468 No abstract available.
  • Mortality after surgery in Europe - Authors' reply.
    Pearse R, Moreno RP, Bauer P, Pelosi P, Metnitz P, Spies C, Vallet B, Vincent JL, Hoeft A, Rhodes A. Pearse R, et al. Lancet. 2013 Feb 2;381(9864):370-1. doi: 10.1016/S0140-6736(13)60164-6. Lancet. 2013. PMID: 23374469 No abstract available.
  • Mortality after surgery in Europe.
    van Schalkwyk JM, Campbell D. van Schalkwyk JM, et al. Lancet. 2013 Feb 2;381(9864):370. doi: 10.1016/S0140-6736(13)60162-2. Lancet. 2013. PMID: 23374470 No abstract available.
  • Mortality after surgery in Europe.
    Brodner G, Van Aken H. Brodner G, et al. Lancet. 2013 Feb 2;381(9864):370. doi: 10.1016/S0140-6736(13)60163-4. Lancet. 2013. PMID: 23374471 No abstract available.
  • [Peri-operative mortality].
    Ekkernkamp A. Ekkernkamp A. Orthopade. 2013 Aug;42(8):663. doi: 10.1007/s00132-013-2114-0. Orthopade. 2013. PMID: 23912306 German. No abstract available.
  • Mortality after surgery in Ireland - Authors' reply.
    Pearse R, Hoeft A, Moreno RP, Pelosi P, Rhodes A. Pearse R, et al. Lancet. 2013 Dec 21;382(9910):2063-4. doi: 10.1016/S0140-6736(13)62686-0. Lancet. 2013. PMID: 24360378 No abstract available.
  • Mortality after surgery in Ireland.
    Doherty S, Conroy RM, Dunne H; ISOS Group. Doherty S, et al. Lancet. 2013 Dec 21;382(9910):2063. doi: 10.1016/S0140-6736(13)62685-9. Lancet. 2013. PMID: 24360379 No abstract available.
  • Post-surgery mortality in Poland.
    Krawczyk S. Krawczyk S. Lancet. 2019 May 18;393(10185):2033-2034. doi: 10.1016/S0140-6736(19)30231-4. Lancet. 2019. PMID: 31106743 No abstract available.

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References

    1. Weiser TG, Regenbogen SE, Thompson KD. An estimation of the global volume of surgery: a modelling strategy based on available data. Lancet. 2008;372:139–144. - PubMed
    1. Findlay G, Goodwin A, Protopappa K, Smith N, Mason M. Knowing the risk: a review of the peri-operative care of surgical patients. National Confidential Enquiry into Patient Outcome and Death; London: 2011.
    1. Pearse RM, Harrison DA, James P. Identification and characterisation of the high-risk surgical population in the United Kingdom. Crit Care. 2006;10:R81. - PMC - PubMed
    1. Jhanji S, Thomas B, Ely A, Watson D, Hinds CJ, Pearse RM. Mortality and utilisation of critical care resources amongst high-risk surgical patients in a large NHS trust. Anaesthesia. 2008;63:695–700. - PubMed
    1. Khuri SF, Henderson WG, DePalma RG, Mosca C, Healey NA, Kumbhani DJ. Determinants of long-term survival after major surgery and the adverse effect of postoperative complications. Ann Surg. 2005;242:326–341. - PMC - PubMed

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