Surgery death rate twice as high as previously thought
Twice as many people die after surgery in NHS hospitals as previously thought according to a new report that finds serious shortcomings in the way many patients are treated.The overall chance of dying within two months of surgery is one in 28 (3.6 per cent), found the study published in The Lancet.
Dr Rupert Pearse, who led the research, described its findings as “very worrying” and said many patients were simply not getting the care they should. “We need to act,” he said.
People at a high risk of dying from surgery were routinely not being told of the dangers, said doctors, often because hospital staff were not identifying them properly.
Patients were also being sent back to general wards after surgery rather than critical care beds because of a “one-size fits all” approach that was “ingrained” in the NHS.
Dr Pearse, a reader in intensive care medicine at Barts and the London School of Medicine and Dentistry, said lessons needed to be learnt from cardiac surgery, where information on death rates was freely available and hospitals vied to be the best
A previous report, published last December by the National Confidential Enquiry for Patient Outcome and Death (NCEPOD), found the chance of dying within 30 days of surgery was just one in 63 (1.6 per cent).
But Dr Pearse said the difference between the two figures could not simply be explained by more patients dying in the second month.
“The great majority of deaths happen in the first seven to 10 days after surgery.”
Patients undergoing specialist surgery are treated differently, for example by dedicated teams on dedicated wards. Dr Pearse argued that meant they essentially received better care.
He said the mortality rate among adult cardiac patients was now less than two per cent – even though they tended to be older, have worse health, and require more dangerous surgery than average.
“If we did the types of things that we did in cardiac surgery, in all types of surgery, outcomes would improve.
Cardiac patients are treated by specialist teams of surgeons and anaesthetists and cared for by specialist nurses on dedicated wards.
Dr Pearse also said outcomes for cardiac surgery had improved markedly since the mid 90s, partly due to changes triggered by the Bristol Royal Infirmary scandal. Between 1990 and 1995, 35 babies died in its cardiac unit and dozens more were brain damaged due to lack of staff, leadership, and scrutiny.
This led to cardiac units being constantly audited, with results now published online.
“I think the reason we see such amazing care and excellent outcomes with cardiac surgery, is that hospitals compete with each other,” he said. “If they find that their hospital is below par, they want to improve it.”
Doctors concede that there is simply not the money to provide such a level of care for all patients.
Tags: Accident and Emergency, Doctors, Health Professionals, Lancet, NHS Deaths, postcode lottery, preventable crisis, RCS, Surgeons