High-risk patients account for nearly 80% of post-surgery deaths.
This is according to a UK study that urges more open conversations and tailored care.
The research, led by Queen Mary University of London and funded by the National Institute for Health and Care Research (NIHR), 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.
Although surgery is now safer and often the best treatment, the study highlights the need to identify high-risk patients early, tailor care to their needs, and improve doctor-patient conversations about risks and long-term outcomes.
High-risk, older patients with long-term conditions often suffer poor outcomes not due to surgical or anaesthetic errors but because of post-op complications linked to age, frailty, and chronic illnesses.
This highlights the need for investment in specialist perioperative services that care for these patients throughout the surgical process.
Rupert Pearse, professor and consultant in Intensive Care Medicine at Queen Mary University of London and Bart’s 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 added: ‘For many years, surgical success has often been judged by survival at 30 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.’
Dr Tom Abbott, co-lead author of the study and clinical senior lecturer in Anaesthesia and Perioperative Medicine at Queen Mary, said: ‘Surgery and anaesthesia 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 emphasises 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 anaesthetists. 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.’
The study is one of the largest analyses of surgical outcomes ever conducted in the UK.
