1. International seven day cohort study of standards of care and clinical outcomes for non-cardiac surgery European Surgical Outcomes Study (EuSOS)

2. EuSOS Objectives of talk Describe current data on surgical outcome Explain why we need better data for Europe Describe study design and methods Explain data collection Provide contact details

3. 234 million major surgical procedures worldwide 4,000 procedures per 100,000 population overall 11,000 procedures per 100,000 in high income countries

4. 80% of surgical deaths are from the high-risk population Pearse et al. Crit Care 2006; 10: R81.

5. Poor outcomes from high-risk surgery are hidden by large numbers of low risk cases Pearse et al. Crit Care; 2006; 10 R81. Standard riskHigh riskp n3,603,803513,924- Age (years)54 (38-69)75 (63-83)<0.0001 Emergencies (%)769,371 (21.3%)454,924 (88.5%)<0.0001 Hospital stay (days) 3 (1-6)16 (9-29) <0.0001 Mortality (%) 15,038 (0.42%)63,340 (12.3%) <0.0001

6. Estimated annual figures for European high-risk surgical population 21 million in-patient general procedures 2.6 million high-risk procedures 1.3 million patients develop complications 315,000 deaths Weiser T. Lancet 2008; 372: 139–44 Ghaferi A. N Engl J Med 2009; 361: 1368-75 Pearse R. Crit Care 2006; 10: R81

7. Surgical complications decrease long-term survival Khuri et al. Ann Surg 2005; 242: 326–343

8. Surgical mortality varies widely in USA Ghaferi A. N Engl J Med 2009; 361: 1368-75.

9. Poor quality of surgical outcome data Inaccurate healthcare systems data Specialty society data on limited subsets Mostly retrospective analyses Too much focus on elective surgery No comparative data across Europe

10. Hospital mortality rate Duration of hospital stay Standard of peri-operative care Do standards of care differ across Europe? Does mortality differ across Europe? What determines admission to critical care after surgery? EuSOS: for in-patient non-cardiac surgery, what is the…

11. Observational seven day cohort study Follow-up to hospital discharge Basic dataset for all adult non-cardiac surgery Follow-up for clinical outcomes (inc crit care) Web-site entry of anonymous patient data EuSOS: Study design

12. EuSOS: Inclusion criteria All adult patients undergoing in-patient non-cardiac surgery during the seven day study period Start: 09:00 4 th April 2011 Finish: 08:59 11 th April 2011

13. EuSOS: Exclusion criteria No planned overnight hospital stay Neurosurgery Obstetrics Cardiac surgery (thoracic surgery is included)

14. EuSOS: Data collection Data set as small as possible......! Hospital data form: describing size, case mix, etc Operating room form: describing all patients Critical Care form: only for admissions to critical care –NB defined as a unit which can routinely ventilate overnight Internet based entry from paper case records

15. EuSOS: Data set Age Gender ASA grade Co-morbid disease Procedure category Urgency Duration Anaesthetic technique Cardiac output monitoring Seniority of medical staff Recovery stay (hours) Critical care stay Ventilation within 24 hours Data for SAPS III & SOFA Inotrope / vasopressor use Duration of hospital stay In-hospital mortality

16. Outcome measures Primary: –In-hospital mortality Secondary: –Duration of hospital stay –Duration of critical care stay

17. EuSOS: Study sites So far, over 300 hospitals in 30 nations Geographical Europe (EU and non-EU nations) National co-ordinators in each nation Local co-ordinators in each hospital

18. EuSOS: Risks of failure Enough hospitals to represent national practice Poor data capture (completion of data forms) Poor data return (internet data entry)

19. EuSOS: Opportunities Provide powerful data to improve patient care International benchmark for each hospital Formation of international research group Public recognition for every investigator Data sharing for future research

20. EuSOS: Steering committee Rupert Pearse (chief investigator)UK Peter Bauer (statistician)Austria Philipp MetnitzAustria Rui MorenoPortugal Paolo PelosiItaly Andy RhodesUK Claudia SpiesGermany Benoit Vallet France Jean-Louis VincentBelgium

21. info@eusos.esicm.org http://eusos.esicm.org EuSOS: Information