The European Society of Anaesthesiology (ESA) is calling for new research into how to improve the surgical outcomes of patients, including better ways of monitoring and preventing complications in those at highest risk of death. The call comes following the publication of the European Surgical Outcomes Study (EuSOS), partly funded by ESA and published in The Lancet.
EuSOS showed that in some European countries, non-cardiac surgical mortality was higher than previously thought. “Of particular concern to ESA is that the study reveals that critical care resources do not appear to be allocated to the patients at highest risk of death,” says Professor Andreas Hoeft, Chairman of ESA’s Research Committee and co-author on The Lancet paper.
The study reveals startling differences in non-cardiac surgical mortality across European countries – in many cases higher than previous national estimates. For example, surgical mortality is 3.6% in the United Kingdom compared with previous national estimates of one to two percent. Alarmingly, 73% of those who died had never been admitted to critical care wards after their surgery. Of those that were admitted to critical care after surgery, 43% then died after being transferred to a regular ward. ESA says these findings raise questions over the allocation of these vital facilities in hospitals across Europe. Furthermore, the overall European surgical mortality figure of four percent contrasts sharply with the two percent mortality following emergency cardiac surgery, in which admission to critical care is generally standard.
“Simply calling for more intensive care unit (ICU) beds will not solve the problem. No health system in Europe can afford to transfer all surgical patients routinely to an ICU or intermediate care, as it is current practice in cardiac surgery and most neurosurgery,” says Hoeft, based at the Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Germany. “New, cost-effective ways of identifying and monitoring patients at risk must be developed. These findings provide further evidence that current clinical practice fails to identify patients at risk at an early stage and to detect and treat complications early enough. We might need such cost-effective monitoring and alarm systems on regular wards in the future,” he adds.
Data from EuSOS was first presented in June at Euroanaesthesia 2012, the annual congress of ESA. The study was funded through a joint research grant from ESA and the European Society of Intensive Care Medicine (ESICM). EuSOS is part of ESA’s Clinical Trials Network – an initiative set up by the society in 2010 to increase focus on the clinical research needed to help anaesthesia progress.
ESA awarded a grant for data collection and statistical analysis to EuSOS chief investigator Rupert Pearse, and also provided travel grants for study meetings. “It’s important to note that all the centres involved in EuSOS gave their data voluntarily for the good of anaesthesiology,” concludes Hoeft. “The European Society of Anaesthesiology will strive to advance research in this area in the future, but the extent to which we can rely on voluntary contributions of the enthusiastic researchers may in future be limited, and we will need some solid funding from public sources such as Member State and European Governments to answer the questions raised by the EuSOS data.”
