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Improving outcomes after surgery

BMJ 2009; 339 doi: (Published 11 December 2009) Cite this as: BMJ 2009;339:b5173
  1. Michael P W Grocott, director, Surgical Outcomes Research Centre
  1. 1Joint University College London Hospital/University College London Comprehensive Biomedical Research Centre, London WC1E 6BT
  1. mike.grocott{at}

    Early recognition and treatment of complications, and high quality clinical databases are key

    About 230 million major surgical procedures are performed worldwide each year,1 and morbidity and mortality after surgery vary widely. A recent study of more than four million patients in the United Kingdom found hospital mortality after surgery to be 1.9% (0.44% in elective procedures, 5.4% in emergency procedures).2 A study of 300 000 patients by the National Surgical Quality Improvement Program (NSQIP) in the United States reported that 30 day mortality was 1.8% and that 12.2% of patients had complications.3 This similarity in reported mortality may be misleading because “raw” (unadjusted) mortality and rates of complications depend on the population studied and the criteria used.4 However, using an alternative definition of postoperative harm, the postoperative morbidity survey, the prevalence of clinically relevant postoperative morbidity in patients undergoing major surgery in a UK teaching hospital (hospital mortality 1.4%) was 53% on day 5 and 31% on day 8.5

    Two recent publications highlight the long term implications of surgical complications. The presence of complications within 30 days of surgery was reported to be the strongest determinant of decreased postoperative survival.6 Similarly, taking “sickness absence” for more than seven days after any operation …

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