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 Hamilton; Dagan 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

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, 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

Clinic of Anesthesiology

829 Citations (Scopus)

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 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 language	English
Journal	The Lancet
Volume	380
Issue number	9847
Pages (from-to)	1059-1065
Number of pages	7
ISSN	0140-6736
DOIs	https://doi.org/10.1016/S0140-6736(12)61148-9
Publication status	Published - 01.09.2012

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10.1016/S0140-6736(12)61148-9

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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., Fagnoul, D., van Obbergh, L., Al-Subaie, N., Arif, F., Cashman, J., Cecconi, M., Edsell, M., Fossati, N., Hammond, S. J., ... Weber, M. (2012). Mortality after surgery in Europe: A 7 day cohort study. The Lancet, 380(9847), 1059-1065. https://doi.org/10.1016/S0140-6736(12)61148-9

@article{9d459d6d238d479c8ae334f33d481b24,

title = "Mortality after surgery in Europe: A 7 day cohort study",

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 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.",

author = "Pearse, {Rupert M.} and Moreno, {Rui P.} and Peter Bauer and Paolo Pelosi and Philipp Metnitz and Claudia Spies and Benoit Vallet and Vincent, {Jean Louis} and Andreas Hoeft and Andrew Rhodes and David Fagnoul and {van Obbergh}, Luc and Nawaf Al-Subaie and Fuhazia Arif and Jeremy Cashman and Maurizio Cecconi and Mark Edsell and Nicoletta Fossati and Hammond, {Sarah Jane} and Mark Hamilton and Dagan Lonsdale and Carl Moran and Claas Siegmueller and Freya Velzeboer and Patrick Wong and Eli Awlakpui and Mona Scheidemann and Maria Wittmann and Sandrine Damster and Kim Golder and Russell Hewson and Marta Januszewska and Brigitte Leva and Vasco Ramos and Eric Hoste and Luc Huyghens and Rita Jacobs and {Van Mossevelde}, Veerle and Godelieve Opdenacker and Jan Poelaert and Herbert Spapen and Kris Leleu and Dirk Rijckaert and {De Decker}, Koen and Luc Foubert and {De Neve}, Nikolaas and Patrick Biston and Michael Piagnerelli and Carla Nau and Matthias Weber",

note = "Funding Information: This study was funded by the European Society of Intensive Care Medicine and the European Society of Anaesthesiology. RP is a National Institute for Health Research (UK) Clinician Scientist. ",

year = "2012",

month = sep,

day = "1",

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

language = "English",

volume = "380",

pages = "1059--1065",

journal = "The Lancet",

issn = "0140-6736",

number = "9847",

}

Pearse, RM, Moreno, RP, Bauer, P, Pelosi, P, Metnitz, P, Spies, C, Vallet, B, Vincent, JL, Hoeft, A, Rhodes, A, Fagnoul, D, van Obbergh, L, Al-Subaie, N, Arif, F, Cashman, J, Cecconi, M, Edsell, M, Fossati, N, Hammond, SJ, Hamilton, M, Lonsdale, D, Moran, C, Siegmueller, C, Velzeboer, F, Wong, P, Awlakpui, E, Scheidemann, M, Wittmann, M, Damster, S, Golder, K, Hewson, R, Januszewska, M, Leva, B, Ramos, V, Hoste, E, Huyghens, L, Jacobs, R, Van Mossevelde, V, Opdenacker, G, Poelaert, J, Spapen, H, Leleu, K, Rijckaert, D, De Decker, K, Foubert, L, De Neve, N, Biston, P, Piagnerelli, M, Nau, C & Weber, M 2012, 'Mortality after surgery in Europe: A 7 day cohort study', The Lancet, vol. 380, no. 9847, pp. 1059-1065. 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 - Fagnoul, David

AU - van Obbergh, Luc

AU - Al-Subaie, Nawaf

AU - Arif, Fuhazia

AU - Cashman, Jeremy

AU - Cecconi, Maurizio

AU - Edsell, Mark

AU - Fossati, Nicoletta

AU - Hammond, Sarah Jane

AU - Hamilton, Mark

AU - Lonsdale, Dagan

AU - Moran, Carl

AU - Siegmueller, Claas

AU - Velzeboer, Freya

AU - Wong, Patrick

AU - Awlakpui, Eli

AU - Scheidemann, Mona

AU - Wittmann, Maria

AU - Damster, Sandrine

AU - Golder, Kim

AU - Hewson, Russell

AU - Januszewska, Marta

AU - Leva, Brigitte

AU - Ramos, Vasco

AU - Hoste, Eric

AU - Huyghens, Luc

AU - Jacobs, Rita

AU - Van Mossevelde, Veerle

AU - Opdenacker, Godelieve

AU - Poelaert, Jan

AU - Spapen, Herbert

AU - Leleu, Kris

AU - Rijckaert, Dirk

AU - De Decker, Koen

AU - Foubert, Luc

AU - De Neve, Nikolaas

AU - Biston, Patrick

AU - Piagnerelli, Michael

AU - Nau, Carla

AU - Weber, Matthias

N1 - Funding Information: This study was funded by the European Society of Intensive Care Medicine and the European Society of Anaesthesiology. RP is a National Institute for Health Research (UK) Clinician Scientist.

PY - 2012/9/1

Y1 - 2012/9/1

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 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.

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 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.

UR - http://www.scopus.com/inward/record.url?scp=84866510395&partnerID=8YFLogxK

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

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

M3 - Journal articles

C2 - 22998715

AN - SCOPUS:84866510395

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

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