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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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Presentation Transcript
slide1

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

slide2

234 million major surgical procedures worldwide

  • 4,000 procedures per 100,000 population overall
  • 11,000 procedures per 100,000 in high income countries
the high risk surgical patient
The high-risk surgical patient

Elderly

Co-morbid disease

Major surgery

Emergency surgery

slide6

Mortality in selected UK general surgical populations

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

slide8

Mortality following non-cardiac surgery in an NHS Trust

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

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
slide11

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

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

slide12
Risk prediction for common surgical procedures performed in the UKAylin et al. BMJ; 2007(online first)
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
placebo 72 deaths among 459 patients 16
Placebo: 72 deaths among 459 patients (16%)

Metoprolol: 74 deaths among 462 patients (16%)

slide25
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