Tuesday, September 25, 2012

Surgical Mortality in Europe

A fascinating paper just published in the Lancet, outlining rates of mortality up to 7 days post operatively across 28 European countries. Data on over 46000 patients was collected. Crude mortality ranged from 1.2% of all cases in Iceland to >20% in Latvia. When adjusted for confounding variables, e.g. smoking, COPD etc, there was a TEN FOLD difference between the best and worst performing systems.

"When compared with the UK, the recorded mortality rates for Poland, Latvia, Romania, and Ireland were higher even after adjustment for all identified confounding variables. This pattern could relate to cultural, demographic, socioeconomic, and political differences between nations, which might affect population health and health-care outcomes."

However there may be other explanations, including the size and volume of surgical units, availability and expertise of intensive care, staffing, training and use (or lack of use) of approaches known to reduce morbidity and mortality such as pre-operative briefings (Gawande and others), appropriate antimicrobial prophylaxis and VTE prophylaxis. Regardless of the cause, yet again we see evidence of huge variation. Time to start learning why this exists.