European Surgical Outcomes Study
(EuSOS)
International seven day cohort study of
standards of care and clinical outcomes
for non-cardiac surgery
EuSOS
Objectives of talk
• Describe current data on surgical outcome
• Explain why we need better data for Europe
• Describe study design and methods
• Explain data collection
• Provide contact details
• 234 million major surgical procedures worldwide
• 4,000 procedures per 100,000 population overall
• 11,000 procedures per 100,000 in high income countries
Population size (millions)
15
4
10
3
2
5
1
0
Post-operative mortality (%)
5
0
Overall
Standard
Size
High-risk
M ortality
80% of surgical deaths are from the high-risk population
Pearse et al. Crit Care 2006; 10: R81.
Standard risk
High risk
p
n
3,603,803
513,924
-
Age (years)
54 (38-69)
75 (63-83)
<0.0001
Emergencies (%)
769,371 (21.3%)
454,924 (88.5%)
<0.0001
Hospital stay (days)
3 (1-6)
16 (9-29)
<0.0001
Mortality (%)
15,038 (0.42%)
63,340 (12.3%)
<0.0001
Poor outcomes from high-risk surgery are hidden
by large numbers of low risk cases
Pearse et al. Crit Care; 2006; 10 R81.
Estimated annual figures for European
high-risk surgical population
• 21 million in-patient general procedures
• 2.6 million high-risk procedures
• 1.3 million patients develop complications
• 315,000 deaths
Weiser T. Lancet 2008; 372: 139–44
Ghaferi A. N Engl J Med 2009; 361: 1368-75
Pearse R. Crit Care 2006; 10: R81
Surgical complications decrease
long-term survival
Khuri et al. Ann Surg 2005; 242: 326–343
Surgical mortality varies widely in USA
Ghaferi A. N Engl J Med 2009; 361: 1368-75.
Poor quality of surgical outcome data
• Inaccurate healthcare systems data
• Specialty society data on limited subsets
• Mostly retrospective analyses
• Too much focus on elective surgery
• No comparative data across Europe
EuSOS: for in-patient non-cardiac surgery,
what is the…
•
Hospital mortality rate
•
Duration of hospital stay
•
Standard of peri-operative care
•
Do standards of care differ across Europe?
•
Does mortality differ across Europe?
•
What determines admission to critical care after surgery?
EuSOS: Study design
•
Observational seven day cohort study
•
Follow-up to hospital discharge
•
Basic dataset for all adult non-cardiac surgery
•
Follow-up for clinical outcomes (inc crit care)
•
Web-site entry of anonymous patient data
EuSOS: Inclusion criteria
All adult patients undergoing
in-patient non-cardiac surgery during
the seven day study period
Start: 09:00 4th April 2011
Finish: 08:59 11th April 2011
EuSOS: Exclusion criteria
• No planned overnight hospital stay
• Neurosurgery
• Obstetrics
• Cardiac surgery (thoracic surgery is included)
EuSOS: Data collection
• Data set as small as possible......!
• Hospital data form: describing size, case mix, etc
• Operating room form: describing all patients
• Critical Care form: only for admissions to critical care
– NB defined as a unit which can routinely ventilate overnight
• Internet based entry from paper case records
EuSOS: Data set
• Age
• Seniority of medical staff
• Gender
• Recovery stay (hours)
• ASA grade
• Critical care stay
• Co-morbid disease
• Procedure category
• Urgency
• Duration
• Ventilation within 24 hours
• Data for SAPS III & SOFA
• Inotrope / vasopressor use
• Anaesthetic technique
• Duration of hospital stay
• Cardiac output monitoring
• In-hospital mortality
Outcome measures
• Primary:
– In-hospital mortality
• Secondary:
– Duration of hospital stay
– Duration of critical care stay
EuSOS: Study sites
• So far, over 300 hospitals in 30 nations
• Geographical Europe (EU and non-EU nations)
• National co-ordinators in each nation
• Local co-ordinators in each hospital
EuSOS: Risks of failure
• Enough hospitals to represent national practice
• Poor data capture (completion of data forms)
• Poor data return (internet data entry)
EuSOS: Opportunities
• Provide powerful data to improve patient care
• International benchmark for each hospital
• Formation of international research group
• Public recognition for every investigator
• Data sharing for future research
EuSOS: Steering committee
• Rupert Pearse (chief investigator)
UK
• Peter Bauer (statistician)
Austria
• Philipp Metnitz
Austria
• Rui Moreno
Portugal
• Paolo Pelosi
Italy
• Andy Rhodes
UK
• Claudia Spies
Germany
• Benoit Vallet
France
• Jean-Louis Vincent
Belgium
EuSOS:
Information
info@eusos.esicm.org
http://eusos.esicm.org