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Identification and characterisation of the high-risk surgical population in the United Kingdom.

Pearse, RM; Harrison, DA; James, P; Watson, D; Hinds, C; Rhodes, A; Grounds, RM; Bennett, ED (2006) Identification and characterisation of the high-risk surgical population in the United Kingdom. Crit Care, 10 (3). R81. ISSN 1466-609X
SGUL Authors: Rhodes, Andrew

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INTRODUCTION: Little is known about mortality rates following general surgical procedures in the United Kingdom. Deaths are most common in the 'high-risk' surgical population consisting mainly of older patients, with coexisting medical disease, who undergo major surgery. Only limited data are presently available to describe this population. The aim of the present study was to estimate the size of the high-risk general surgical population and to describe the outcome and intensive care unit (ICU) resource use. METHODS: Data on inpatient general surgical procedures and ICU admissions in 94 National Health Service hospitals between January 1999 and October 2004 were extracted from the Intensive Care National Audit & Research Centre database and the CHKS database. High-risk surgical procedures were defined prospectively as those for which the mortality rate was 5% or greater. RESULTS: There were 4,117,727 surgical procedures; 2,893,432 were elective (12,704 deaths; 0.44%) and 1,224,295 were emergencies (65,674 deaths; 5.4%). A high-risk population of 513,924 patients was identified (63,340 deaths; 12.3%), which accounted for 83.8% of deaths but for only 12.5% of procedures. This population had a prolonged hospital stay (median, 16 days; interquartile range, 9-29 days). There were 59,424 ICU admissions (11,398 deaths; 19%). Among admissions directly to the ICU following surgery, there were 31,633 elective admissions with 3,199 deaths (10.1%) and 24,764 emergency admissions with 7,084 deaths (28.6%). The ICU stays were short (median, 1.6 days; interquartile range, 0.8-3.7 days) but hospital admissions for those admitted to the ICU were prolonged (median, 16 days; interquartile range, 10-30 days). Among the ICU population, 40.8% of deaths occurred after the initial discharge from the ICU. The highest mortality rate (39%) occurred in the population admitted to the ICU following initial postoperative care on a standard ward. CONCLUSION: A large high-risk surgical population accounts for 12.5% of surgical procedures but for more than 80% of deaths. Despite high mortality rates, fewer than 15% of these patients are admitted to the ICU.

Item Type: Article
Additional Information: © 2006 Pearse et al.; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Keywords: Adult, Aged, Databases, Factual, Elective Surgical Procedures, Emergency Medical Services, Female, Humans, Intensive Care Units, Length of Stay, Male, Middle Aged, Postoperative Complications, Prospective Studies, Risk Factors, United Kingdom, Humans, Postoperative Complications, Length of Stay, Risk Factors, Prospective Studies, Databases, Factual, Adult, Aged, Middle Aged, Intensive Care Units, Emergency Medical Services, Female, Male, Elective Surgical Procedures, United Kingdom, 11 Medical And Health Sciences, Emergency & Critical Care Medicine
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Academic Structure > Molecular and Clinical Sciences Research Institute (MCS) > Cell Sciences (INCCCS)
Journal or Publication Title: Crit Care
ISSN: 1466-609X
Language: eng
2 June 2006Published
25 April 2006Accepted
Publisher License: Creative Commons: Attribution 2.0
PubMed ID: 16749940
Web of Science ID: WOS:000240436500012
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