Mortality after surgery in Europe: a 7 day cohort study

Pearse, Rupert M., Moreno, Rui P., Bauer, Peter, Pelosi, Paolo, Metnitz, Philipp, Spies, Claudia, Vallet, Benoit, Vincent, Jean-Louis, Hoeft, Andreas, Rhodes, Andrew and Grocott, M.P.W. , European Surgical Outcomes Study (EuSOS) Group (2012) Mortality after surgery in Europe: a 7 day cohort study. The Lancet, 380 (9847), 1059-1065. (doi:10.1016/S0140-6736(12)61148-9). (PMID:23374467)

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 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 patients.

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

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Contributors

Author: M.P.W. Grocott

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