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, David Fagnoul, Luc van Obbergh, Nawaf Al-Subaie, Fuhazia Arif, Jeremy Cashman, Maurizio Cecconi, Mark Edsell, Nicoletta Fossati, Sarah Jane Hammond, Mark HamiltonDagan Lonsdale, Carl Moran, Claas Siegmueller, Freya Velzeboer, Patrick Wong, Eli Awlakpui, Mona Scheidemann, Maria Wittmann, Sandrine Damster, Kim Golder, Russell Hewson, Marta Januszewska, Brigitte Leva, Vasco Ramos, Eric Hoste, Luc Huyghens, Rita Jacobs, Veerle Van Mossevelde, Godelieve Opdenacker, Jan Poelaert, Herbert Spapen, Kris Leleu, Dirk Rijckaert, Koen De Decker, Luc Foubert, Nikolaas De Neve, Patrick Biston, Michael Piagnerelli, Carla Nau, Matthias Weber

*Corresponding author for this work
829 Citations (Scopus)


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 χ2and 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 languageEnglish
JournalThe Lancet
Issue number9847
Pages (from-to)1059-1065
Number of pages7
Publication statusPublished - 01.09.2012


Dive into the research topics of 'Mortality after surgery in Europe: A 7 day cohort study'. Together they form a unique fingerprint.

Cite this