Reducing Surgical Mortality and Complications

Abstract

In the general surgical population, the risk of death within 30 days of an operation is estimated at between 0.7% and 1.7% for most operations and only rises to between 4 and 10% for more risky operations such as cardiac or vascular surgery. However, data from a number of sources suggests that there are a group of surgical patients whose post-operative mortality is between 15 and 35% (Table 1). In England, Wales and Northern Ireland, approximately 2.8 million surgical operations are performed each year and approximately 20000 deaths within 30 days of operation are reported to the National Confidential Enquiry into Post Operative Deaths (NCEPOD). Of these deaths 87% were aged over 60 and 77% were over 70 years of age. Eighty-five percent of these patients had coexisting medical disorders, 45% had significant cardiovascular disease and 30% had significant respiratory disease [1]. The surgeons performing the surgery considered that there was a definite risk of death in nearly 60% of these cases and death was expected in nearly 10% of cases. Respiratory disorders were implicated in nearly 40% of these deaths and cardiac disorders were implicated in over 35% of deaths. Despite this, only 32% of these patients were admitted to an intensive care unit (ICU) or other high care area such as a high dependency unit (HDU). NCEPOD has recognized that those patients who die after surgery are more likely to be elderly, have pre-existing medical disorders and that most deaths occur after abdominal, colorectal or major orthopedic surgery.