Should we worry about
Download
1 / 26

Should we worry about surgical outcomes? Rupert Pearse Senior Lecturer in Intensive Care Medicine - PowerPoint PPT Presentation


  • 212 Views
  • Uploaded on

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

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about ' Should we worry about surgical outcomes? Rupert Pearse Senior Lecturer in Intensive Care Medicine' - sidone


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript

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



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


The high risk surgical patient
The high-risk surgical patient Enquiry into Peri-Operative Deaths

Elderly

Co-morbid disease

Major surgery

Emergency surgery


Mortality in selected UK general surgical populations Enquiry into Peri-Operative Deaths

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


Standard and high risk surgical populations in the uk pearse et al crit care 2006 10 r81
Standard and high-risk surgical populations in the UK Enquiry into Peri-Operative DeathsPearse et al. Crit Care; 2006; 10 R81.


Mortality following non-cardiac surgery in an NHS Trust Enquiry into Peri-Operative Deaths

Jhanji et al Anaesthesia 2008; 63(7): 695-701



Annual figures for the uk high risk surgical population
Annual figures for the UK carehigh-risk surgical population

  • 1.4 million in-patient general procedures

  • 166,000 high-risk surgical procedures

  • 100,000 patients develop complications

  • 25,000 deaths


‘Quality and process improvement…. should be directed toward prevention of postoperative complications.’

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


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


High risk surgery comparison with the cardiac surgery model
High-risk surgery: the UKComparison with the cardiac surgery model


Uk cardiac surgical register 1977 2000 society for cardiothoracic surgeons of great britain ireland

30 the UK

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


Why are outcomes so much better for cardiac surgical patients
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


The high risk surgical patient just a uk problem
The high-risk surgical patient: patients?Just a UK problem?


Mortality for common surgical procedures in the usa khuri et al ann surg 2005 242 326 343
Mortality for common surgical procedures in the USA patients?Khuriet al. Ann Surg 2005; 242: 326–343.


Placebo 72 deaths among 459 patients 16
Placebo: 72 deaths among 459 patients (16%) patients?

Metoprolol: 74 deaths among 462 patients (16%)


Outcomes across the uk comparison of england and scotland
Outcomes across the UK: patients?Comparison of England and Scotland



Critical care resources in scotland and england
Critical care resources in Scotland and England Scottish Audit of Surgical Mortality


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


High risk surgery is an important healthcare problem
High-risk surgery is an important healthcare problem Scottish Audit of Surgical Mortality

  • Acknowledge the problem

  • Identifying the high-risk patient

  • Effective intervention

  • Adequate resources

  • Quality research

  • Reliable outcome data


ad