Variability of surgical outcomes and the EuSOS Study

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Variability of surgical outcomes and the EuSOS Study

Variability of surgical outcomes

and the EuSOS Study

Rupert Pearse

Barts and The London School of Medicine & Dentistry

London, UK.


• 234 million major surgical procedures worldwide

• 4,000 procedures per 100,000 population overall

• 11,000 procedures per 100,000 in high income countries


Population size (millions)

5

4

3

2

1

0

Overall Standard High-risk

Size Mortality

80% of surgical deaths are from the high-risk population

Pearse et al. Crit Care 2006; 10: R81.

15

10

5

0

Post-operative mortality (%)


Estimated annual figures for European

high-risk surgical population

• 21 million in-patient general procedures

• 2.6 million high-risk procedures

• 1.3 million patients develop complications

• 315,000 deaths

Weiser T. Lancet 2008; 372: 139–44

Ghaferi A. N Engl J Med 2009; 361: 1368-75

Pearse R. Crit Care 2006; 10: R81


From safer surgery to safer peri-

operative care...


Surgical complications decrease

long-term survival

Khuri et al. Ann Surg 2005; 242: 326–343


Surgical mortality varies widely in USA

Ghaferi A. N Engl J Med 2009; 361: 1368-75.


Poor quality of surgical outcome data

• Inaccurate healthcare systems data

• Specialty society data on limited subsets

• Mostly retrospective analyses

• Too much focus on elective surgery

• No comparative data across Europe


EuSOS: for in-patient non-cardiac surgery,

what is the

• Hospital mortality rate

• Duration of hospital stay

• Standard of peri-operative care

• Do standards of care differ across Europe?

• Does mortality differ across Europe?

• What determines admission to critical care after surgery?


EuSOS: Study design

• Observational seven day cohort study

• Follow-up to hospital discharge

• Basic dataset for all adult non-cardiac surgery

• Follow-up for clinical outcomes (inc crit care)

• Web-site entry of anonymous patient data


EuSOS: Inclusion criteria

All adult patients undergoing

in-patient non-cardiac surgery during

the seven day study period

Start: 09:00 4 th April 2011

Finish: 08:59 11 th April 2011


EuSOS: Exclusion criteria

• No planned overnight hospital stay

• Neurosurgery

• Obstetrics

• Cardiac surgery (thoracic surgery is included)


EuSOS: Data collection

• Refined data set of valid risk factors and outcomes

• Hospital data form: describing size, case mix, etc

• Operating room form: describing all patients

• Critical Care form: only for admissions to critical care

• Internet based entry from paper case records


• Age

• Gender

• ASA grade

• Co-morbid disease

• Procedure category

• Urgency

• Duration

• Anaesthetic technique

• Cardiac output monitoring

EuSOS: Data set

• Seniority of medical staff

• Recovery stay (hours)

• Critical care stay

• Ventilation within 24 hours

• Data for SAPS III & SOFA

• Inotrope / vasopressor use

• Duration of hospital stay

• In-hospital mortality


• Primary:

Outcome measures

– In-hospital mortality

• Secondary:

– Duration of hospital stay

– Duration of critical care stay


EuSOS: Study sites

• 498 hospitals in 28 nations

• Geographical Europe (EU and non-EU nations)

• National co-ordinators in each nation

• Local co-ordinators in each hospital


EuSOS: Importance

• Provide powerful data to improve patient care

• International benchmark for each hospital

• Formation of international research group

• Public recognition for every investigator

• Data sharing for future research


Do we really need epidemiology

in peri-operative care?


CABG operations (thousands)

30

25

20

15

10

5

0

1977

1978

1979

1980

1981

1982

1983

1984

1985

Number Mortality

1986

1987

UK Cardiac Surgical Register

Society for Cardiothoracic Surgeons of Great Britain & Ireland

1988

1989

1990

1991

1992

1993

1994-95

1995-96

1996-97

1997-98

1998-99

1999-00

7%

6%

5%

4%

3%

2%

1%

0%

Mortality


Audit and Quality Improvement


Audit and improved survival

following myocardial infarction


Improving surgical outcomes

• Major healthcare problem

• Identify high-risk patient

• Adapt care to specific individual need

• Don’t tolerate inadequate care

• Audit your results


Improving care for the high-risk patient

Pearse RM et al BMJ 2011; 343: d5759


EuSOS:

Information

info@eusos.esicm.org

http://eusos.esicm.org


Last chance for questions...

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