High-risk patients account for majority of postoperative deaths and readmissions

A major new study, led by Queen Mary University of London and funded by the National Institute for Health and Care Research (NIHR) has been published in The Lancet Public Health. It found that out of the five million surgical procedures performed each year by the NHS, around 300,000 are carried out on individuals considered high-risk, and within 90 days of surgery, these high-risk patients account for: 

• four out of five deaths 

• over half of all hospital bed days 

• nearly one-third of emergency readmissions 

While surgery is safer than ever for most people and remains the best treatment option for many conditions, this study highlights the urgent need to identify high-risk patients earlier, to provide care that is better tailored to their individual needs, and for doctors and patients to have more open, honest conversations about the risks and long-term outcomes for surgery at an individual level. 

It also shows that high-risk patients, who tend to be older and live with several long-term health conditions such as heart disease, have poor outcomes not because of technical failings in surgery or anesthesia, but due to post-operative complications relating to chronic health conditions, age and frailty. Therefore, the findings demonstrate the need for greater investment in specialist perioperative services that focus on the care of older, high-risk patients before, during and after surgery. 

Rupert Pearse, Professor and Consultant in Intensive Care Medicine at Queen Mary University of London and Barts Health NHS Trust, and co-lead of the study said: "While surgery is safer than ever before, our findings clearly show that high-risk patients are more likely to have poor outcomes and experience harm after surgery than those deemed low-risk. 

"Although these patients make up fewer than one in ten surgical cases, their numbers are increasing as the population ages and more people live longer with chronic illness. It is therefore vital that we work to improve care for this group of patients, pre- and post-surgery, including having open conversations with patients about the individual risk of their procedure."

He continues: "For many years, surgical success has often been judged by survival at thirty days. Our study shows that this measure does not give the full picture of what happens to many high-risk patients in the months and years after surgery. By looking at longer-term survival and other factors such as time spent in hospital and quality of life, we could make a real difference to patients and potentially help relieve pressure on the wider NHS." 

Surgery and anesthesia are safer today than ever before, helping to save and improve the lives of millions of people across the UK every year.

This new research emphasizes that the decision to have surgery is a choice each individual should make for themselves, having understood the benefits as well as the risks explained by their surgeons and anesthetists. There will always be a small number of people for whom the risks of surgery outweigh the benefits.

The Royal College of Anaesthetists is working to improve specialist perioperative care services for high-risk patients, so we can provide each person the tailored care they need to have the best chance of a good outcome after their surgery."

Dr. Tom Abbott, co-lead author of the study and Clinical Senior Lecturer in anesthesia and Perioperative Medicine at Queen Mary

The study is one of the largest analyses of surgical outcomes ever carried out in the UK. It analysed health records from 13 million adults who had 16.1 million surgical procedures in England, Scotland and Wales between 2015 and 2019.