Improved care needed for high-risk patients

Evidence gathered for a new National Confidential Enquiry into Patient Outcome & Death (NCEPOD) report – Knowing the Risk: A review of the perioperative care of surgical patients – reveals that there is serious variation in the way different hospitals manage risk for surgical patients, resulting in consistently sub-standard treatment in some hospitals.

 The good news

 The report did contain some good news, finding that advances in surgical and patient care continue to deliver overall good patient outcomes, despite an ageing population, increasing comorbidities and expanding surgical therapies. Risk of death and major complications after surgery in the general surgical patient population are low. Indeed, less than 1% of all patients undergoing surgery die during the same hospital admission.1 However, mortality in some groups of patients were found to be surprisingly high. It is estimated that around 20,000-25,000 deaths per year occur in UK hospitals after a surgical procedure. Of these deaths approximately 80% occur in high-risk patients which are estimated to make up approximately 10% of the overall inpatient surgical workload. This population of high-risk patients has a hospital mortality rate of approximately 10% to 15%.2 Data collected at the time of surgery found that 21% of patients undergoing elective surgery had not been seen in an assessment clinic before their operation and in only 8% of patients defined as ‘high risk’ was risk of death stated on their consent forms. The report compared NHS outcomes with centres in similar sized hospitals and patient populations in the US.3,4 This has raised concerns that UK outcomes may be less good than outcomes in other countries. The NHS appears, as a whole, to have poorer outcomes compared with those in the US and UK mortality appears to be noticeably greater than US mortality – eight fold in the predicted risk of death group between 0% and 5% and three fold in the predicted risk of death group between 11% and 20%.