Postsurgery mortality rates vary across Europe

By Sarah Guy, medwireNews Reporter

Europe-wide data suggest that mortality rates after noncardiac surgery are higher than expected, and vary substantially by country, reports an international research team in The Lancet.

For example, compared with the UK (which had the largest dataset), postsurgery mortality rates were significantly higher for Poland, Latvia, Romania, and Ireland.

Furthermore, among the almost 50,000 patients whose data comprised the study - which included 28 European countries in total - 4% died before being discharged from hospital, yet almost three-quarters of these were not admitted to critical care at any stage after their surgery, observe the authors.

"These findings suggest a systematic failure in the process of allocation of critical care resources," remark Rupert Pearse (Queen Mary University of London, UK) and co-authors.

"Further research is needed to better understand whether early admission to critical care can improve survival after major surgery," they add.

The team conducted a 7-day cohort study of 46,539 surgical patients aged at least 16 years who were treated at 498 hospitals and had a median duration of hospital stay of 3 days. In all, 1855 patients died while in hospital.

A total of 3599 (8%) patients were admitted to critical care at some point during their hospital stay, which was planned in 2555 (71%) cases. Remarkably, write Pearse and team, 1358 (73%) of the patients who died were not admitted to critical care at any stage.

The researchers report that the country where surgery was performed, the urgency and grade of surgery, the procedure category, American Society of Anesthesiologists (ASA) score, presence of metastatic disease, and presence of cirrhosis were all independently associated with mortality, with odds ratios (ORs) for death ranging from 1.59 for major versus minor grade surgery, to 35.61 for ASA score 5 versus 1.

Ireland, Latvia, Poland, and Romania had significantly higher rates of mortality after surgery compared with the UK, with respective ORs of 2.61, 4.98, 6.92, and 3.19.

In a commentary accompanying the research, René Vonlanthen and Pierre-Alain Clavien, from University Hospital Zurich in Switzerland, suggest that future targets for research to understand the "relevant issues and optimum processes to secure quality" could include the type of intensive care beds needed, volume, and surgeons' qualifications.

"Costs for the overall postoperative course would also be key, to allow us to propose cost-effective and relevant corrective measures," the pair concludes.

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