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


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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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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


Should we worry about surgical outcomes rupert pearse senior lecturer in intensive care medicine

  • 234 million major surgical procedures worldwide

  • 4,000 procedures per 100,000 population overall

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


Should we worry about surgical outcomes rupert pearse senior lecturer in intensive care medicine

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


The high risk surgical patient

The high-risk surgical patient

Elderly

Co-morbid disease

Major surgery

Emergency surgery


Should we worry about surgical outcomes rupert pearse senior lecturer in intensive care medicine

Mortality in selected UK general surgical populations

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


Should we worry about surgical outcomes rupert pearse senior lecturer in intensive care medicine

Mortality following non-cardiac surgery in an NHS Trust

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


Less than 1 3 of high risk patients are admitted to critical care

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


Annual figures for the uk high risk surgical population

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


Should we worry about surgical outcomes rupert pearse senior lecturer in intensive care medicine

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

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


Should we worry about surgical outcomes rupert pearse senior lecturer in intensive care medicine

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:Comparison with the cardiac surgery model


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

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


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: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 USAKhuriet al. Ann Surg 2005; 242: 326–343.


Placebo 72 deaths among 459 patients 16

Placebo: 72 deaths among 459 patients (16%)

Metoprolol: 74 deaths among 462 patients (16%)


Outcomes across the uk comparison of england and scotland

Outcomes across the UK:Comparison of England and Scotland


Should we worry about surgical outcomes rupert pearse senior lecturer in intensive care medicine

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


Critical care resources in scotland and england

Critical care resources in Scotland and England


Should we worry about surgical outcomes rupert pearse senior lecturer in intensive care medicine

Surgical admissions to Scottish ICUs in 2006Kerssens 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

  • Acknowledge the problem

  • Identifying the high-risk patient

  • Effective intervention

  • Adequate resources

  • Quality research

  • Reliable outcome data


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