46,539 patients from all over Europe were recruited to the The European Surgical Outcomes Study over 7 days in April 2011 (read here). Day cases, cardiac and neurosurgical patients were excluded. The overall mortality rate was 4% (nearly 1 in 20 patients). 8% of patients were admitted to ICU or HDU at some stage – but, astonishingly, 73% of those who died never saw a critical care practitioner.
For Ireland 856 patients were recruited into the study; 66 went to critical care beds postoperatively. Median hospital stay was 3 days (1.0-6.0). 6.4% died in hospital, with an unadjusted (for severity of illness) odds ratio of death (compared with the UK) of 1.86. When severity of illness was taken into account the OR of death was 2.61. This puts us down the scale of outcomes with Croatia, Slovakia (better), and Romania and Latvia (marginally worse).
What is truely frightening about these data – is that the reference country, the UK, aside from having a similar population to ours, had worse outcomes than they had expected (mortality 3.6% rather than the predicted 1.6%).
It could be argued that these data are skewed by relatively low numbers, recruitment exclusively in academic medical centers (private hospitals cherry pick the healthiest elective surgery patients), the significant limitations of the ASA physical status grade (between 2 and 3 there really should be 3 more grades – clinicians may have also reported patients as a ASA-PS 2 when they really were a 3), reporting bias etc. Alternatively, our patients might do badly because of weaker nursing care at ward level and fewer critical care beds per head of population.
If the anaesthesia and critical care community in Ireland wants to look into this further, perhaps a worthwhile study would be an enthusiatic clinician to pull out the charts of all 856 patients and figure out why Ireland did so badly. Comments?