The Improving Patient Outcomes (ImPrOve) Think Tank, a group of anaesthetists, surgeons and patient representatives, today launched its European Report to address a serious public health issue – death and serious complication rates in the 30-days after high-risk surgery remain high.i In an effort to improve patient safety and outcomes, the Report calls for better physician training on the latest guidelines, funding for modern digital monitoring, greater use of data from modern technologies in health policies and the right for patients to be involved in dialogue about the management of their procedure.

In Europe, 2.4 million patients undergo high-risk surgery every year.ii,iii Evidence from the UK suggests that 80% of postoperative deaths occur in a 10% sub-population of high-risk patients. If this trend continued at a European level, potentially 192,000 will die in the 30-day period after surgery.i While there are many challenges in high-risk surgery, the most alarming complication for the ImPrOve Think Tank is haemodynamic instability, manifested as drops in blood pressure, and known as IOH.i

During high-risk surgery it is vital that blood continues to flow to organs. IOH is common during surgery under general anaesthesia, occurring in up to 99% of patients.i It has the potential to cause tissue damage in any vital organ, but the heart and kidneys are most affected. Recent studies show associations between IOH and increased risk of acute kidney injury (AKI) and myocardial injury iv,v– the leading cause of post-operative mortality.

Postsurgical patients with AKI and myocardial injury stay longer in hospital, have higher readmission rates, and cost more to care for.iv The subsequent financial impact of this also has a significant impact on European healthcare systems. However, if haemodynamic instability is effectively monitored and prevented, these serious complications can be avoided, and patient outcomes can be significantly improved.

“Our mission is to work collaboratively with patient representatives, clinicians and policy makers to improve perioperative patient safety and experience with the help of advanced haemodynamic monitoring technologies”, commented Professor Olivier Huet, ImPrOve Chair and Professor of Anaesthesia and Intensive Care Medicine. “Major gaps still exist in reducing the risk of complications after high-risk surgery across European hospitals, working together is therefore imperative. All stakeholders need to be onboard so that we can create change and address the calls to action.”

By 2050, it is predicted that 1 in 4 people could be over 65.vi With haemodynamic instability reported as high as 83% in more senior patients,vii the ImPrOve Think Tank believe it will be a likely cause of a significant proportion of modifiable postoperative mortality and morbidity in Europe.

“Patients are often unaware of the risks of not receiving innovative digital monitoring technology, so they may not ask for the best perioperative management”, said Ms Luciana Valente, International Relations Manager at SIHA, Italy, and member of the Think Tank. “It is essential that patients are better informed of the key risks associated with their procedure and aware that the use of innovative digital monitoring, and other actions will be taken to mitigate these risks. The more a patient is invested in a procedure, the better the outcomes will be.”

For further information and to download ‘Improving patient safety: why perioperative care and effective monitoring matters” please visit www.improvethinktank.org

References

i Pearse RM, Moreno RP, Bauer P, Pelosi P, Metnitz P, Spies C et al. Mortality after surgery in Europe: a 7-day cohort study. Lancet. 2021; Sep 22;380(9847):1059-65. Available at: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)61148-9/fulltext [accessed July 2021].

ii Preoperative Score to Predict Postoperative Mortality – POSPOM Edward’s Presentation

iii Ghaferi, et al. Variation in Hospital Mortality Associated with Inpatient Surgery. N Engl J Med, 2009.

iv Keuffel EL, Rizzo J, Stevens M, Gunnarsson C, Maheshwari K. Hospital costs associated with intraoperative hypotension among non-cardiac surgical patients in the US: a simulation model. J Med Econ. 2019 Jul;22(7):645-651. Available at: https://www.tandfonline.com/doi/full/10.1080/13696998.2019.1591147 [accessed July 2021]

v Wesselink EM, Kappen TH, Torn HM, Slooter AJC, van Klei WA. Intraoperative hypotension and the risk of postoperative adverse outcomes: a systematic review. Br J Anaesth. 2018 Oct;121(4):706-721. Available at: https://bjanaesthesia.org/article/S0007-0912(18)30376-3/fulltext. [accessed July 2021].

vi United Nations. Ageing. 2019. Available at: https://www.un.org/en/sections/issues-depth/ageing/ [accessed July 2021]

vii Wickham A, Highton D, Martin D, The Pan London Perioperative Audit and Research Network. Care of elderly patients: a prospective audit of the prevalence of hypotension and the use of BIS intraoperatively in 25 hospitals in London. Perioper Med (Lond). 2016; 5: 12. Available at: (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4882849/) [accessed July 2021].