Mortality after surgery in Europe: a 7 day cohort study

Rupert M Pearse; 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; Fang Gao Smith

doi:10.1016/S0140-6736(12)61148-9

Mortality after surgery in Europe: a 7 day cohort study

Rupert M Pearse, 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, Fang Gao Smith

Inflammation and Ageing

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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.

Original language	English
Pages (from-to)	1059-65
Number of pages	7
Journal	The Lancet
Volume	380
Issue number	9847
DOIs	https://doi.org/10.1016/S0140-6736(12)61148-9
Publication status	Published - 22 Sept 2012

Bibliographical note

Keywords

Adult
Aged
Cohort Studies
Critical Care
Europe
Female
Hospital Mortality
Hospitalization
Humans
Length of Stay
Male
Middle Aged
Postoperative Care
Surgical Procedures, Operative
Treatment Outcome

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Pearse, R. M., Moreno, R. P., Bauer, P., Pelosi, P., Metnitz, P., Spies, C., Vallet, B., Vincent, J-L., Hoeft, A., Rhodes, A., European Surgical Outcomes Study (EuSOS) group for the Trials groups of the European Society of Intensive Care Medicine and the European Society of Anaesthesiology, & Gao Smith, F. (2012). Mortality after surgery in Europe: a 7 day cohort study. The Lancet, 380(9847), 1059-65. https://doi.org/10.1016/S0140-6736(12)61148-9

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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.",

keywords = "Adult, Aged, Cohort Studies, Critical Care, Europe, Female, Hospital Mortality, Hospitalization, Humans, Length of Stay, Male, Middle Aged, Postoperative Care, Surgical Procedures, Operative, Treatment Outcome",

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doi = "10.1016/S0140-6736(12)61148-9",

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Pearse, RM, Moreno, RP, Bauer, P, Pelosi, P, Metnitz, P, Spies, C, Vallet, B, Vincent, J-L, Hoeft, A, Rhodes, A, European Surgical Outcomes Study (EuSOS) group for the Trials groups of the European Society of Intensive Care Medicine and the European Society of Anaesthesiology & Gao Smith, F 2012, 'Mortality after surgery in Europe: a 7 day cohort study', The Lancet, vol. 380, no. 9847, pp. 1059-65. https://doi.org/10.1016/S0140-6736(12)61148-9

TY - JOUR

T1 - Mortality after surgery in Europe

T2 - a 7 day cohort study

AU - Pearse, Rupert M

AU - Moreno, Rui P

AU - Bauer, Peter

AU - Pelosi, Paolo

AU - Metnitz, Philipp

AU - Spies, Claudia

AU - Vallet, Benoit

AU - Vincent, Jean-Louis

AU - Hoeft, Andreas

AU - Rhodes, Andrew

AU - European Surgical Outcomes Study (EuSOS) group for the Trials groups of the European Society of Intensive Care Medicine and the European Society of Anaesthesiology

AU - Gao Smith, Fang

PY - 2012/9/22

Y1 - 2012/9/22

N2 - 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.

AB - 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.

KW - Adult

KW - Aged

KW - Cohort Studies

KW - Critical Care

KW - Europe

KW - Female

KW - Hospital Mortality

KW - Hospitalization

KW - Humans

KW - Length of Stay

KW - Male

KW - Middle Aged

KW - Postoperative Care

KW - Surgical Procedures, Operative

KW - Treatment Outcome

U2 - 10.1016/S0140-6736(12)61148-9

DO - 10.1016/S0140-6736(12)61148-9

M3 - Article

C2 - 22998715

SN - 0140-6736

VL - 380

SP - 1059

EP - 1065

JO - The Lancet

JF - The Lancet

IS - 9847

ER -

Mortality after surgery in Europe: a 7 day cohort study

Abstract

Bibliographical note

Keywords

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