Mortality after surgery in Europe: a 7 day cohort study

Pearse, Rupert M. ; Moreno, Rui P. ; Bauer, Peter ; Pelosi, Paolo ; Metnitz, Philipp ; Spies, Claudia ; Benoit Vallet, Benoit ; Vincent, Jean-Louis ; Hoeft, Andreas ; Rhodes, Andrew ; Serón Arbeloa, Carlos (Universidad de Zaragoza) ; for the European Surgical Outcomes Study (EuSOS) group for the Trials groups of the European Society of Intensive Care Medicine and the European Society of Anaesthesiology*

Resumen: 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.

Idioma: Inglés

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

Año: 2012

Publicado en: The Lancet 380, 9847 (2012), 1059-65
ISSN: 0140-6736

Factor impacto JCR: 39.06 (2012)

Categ. JCR: MEDICINE, GENERAL & INTERNAL rank: 2 / 153 = 0.013 (2012) - Q1 - T1

Tipo y forma: Artículo (Versión definitiva)

Área (Departamento): Area Medicina (Dpto. Medicina, Psiqu. y Derm.)