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Should we worry about surgical outcomes? Rupert Pearse Senior Lecturer in Intensive Care Medicine

Should we worry about surgical outcomes? Rupert Pearse Senior Lecturer in Intensive Care Medicine William Harvey Research Institute Barts and the London School of Medicine and Dentistry. 234 million major surgical procedures worldwide 4,000 procedures per 100,000 population overall

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Should we worry about surgical outcomes? Rupert Pearse Senior Lecturer in Intensive Care Medicine

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  1. Should we worry about surgical outcomes? Rupert Pearse Senior Lecturer in Intensive Care Medicine William Harvey Research Institute Barts and the London School of Medicine and Dentistry

  2. 234 million major surgical procedures worldwide • 4,000 procedures per 100,000 population overall • 11,000 procedures per 100,000 in high income countries

  3. Number of deaths reported by the National Confidential Enquiry into Peri-Operative Deaths

  4. The high-risk surgical patient Elderly Co-morbid disease Major surgery Emergency surgery

  5. Mortality in selected UK general surgical populations Pearse et al. Crit Care; 2006; 10 R81.

  6. Standard and high-risk surgical populations in the UKPearse et al. Crit Care; 2006; 10 R81.

  7. Mortality following non-cardiac surgery in an NHS Trust Jhanji et al Anaesthesia 2008; 63(7): 695-701

  8. Less than 1/3 of high-risk patients are admitted to critical care

  9. Annual figures for the UKhigh-risk surgical population • 1.4 million in-patient general procedures • 166,000 high-risk surgical procedures • 100,000 patients develop complications • 25,000 deaths

  10. ‘Quality and process improvement…. should be directed toward prevention of postoperative complications.’ Khuri et al. Ann Surg 2005; 242: 326–343

  11. Risk prediction for common surgical procedures performed in the UKAylin et al. BMJ; 2007(online first)

  12. High-risk surgery:Comparison with the cardiac surgery model

  13. 30 7% 6% Number Mortality 25 5% 20 Mortality 4% 15 CABG operations (thousands) 3% 10 2% 5 1% 0 0% 1987 1988 1989 1990 1991 1992 1993 1983 1984 1985 1986 1977 1978 1979 1980 1981 1982 1994-95 1997-98 1995-96 1996-97 1998-99 1999-00 UK Cardiac Surgical Register 1977-2000Society for Cardiothoracic Surgeons of Great Britain & Ireland

  14. Why are outcomes so much better for cardiac surgical patients? • Younger / Fitter / Elective • Efficient care pathway for single disease group • Strong evidence base guides practice • Post-operative intensive care is standard • Outcome data influences practice

  15. The high-risk surgical patient:Just a UK problem?

  16. Mortality for common surgical procedures in the USAKhuriet al. Ann Surg 2005; 242: 326–343.

  17. Placebo: 72 deaths among 459 patients (16%) Metoprolol: 74 deaths among 462 patients (16%)

  18. Outcomes across the UK:Comparison of England and Scotland

  19. Number of deaths following emergency surgery reported by the Scottish Audit of Surgical Mortality

  20. Critical care resources in Scotland and England

  21. Surgical admissions to Scottish ICUs in 2006Kerssens J SICSAG 2008 unpublished dataPearse et al. Crit Care; 2006; 10 R81.

  22. High-risk surgery is an important healthcare problem • Acknowledge the problem • Identifying the high-risk patient • Effective intervention • Adequate resources • Quality research • Reliable outcome data

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