Professor Olivier Huet, chair of the ImPrOve Think Tank and Professor of Anaesthesia and Intensive Care Medicine
Why are death rates so high in the 30 days post-surgery?
Surgery is scheduled trauma, and there are many factors that contribute to the successes and risks of complex procedures.[i] Surgery produces stress and inflammation that can result in changes to bodily function, such as a fall in blood pressure.
Blood is pumped around the body under pressure to ensure that tissues and organs receive adequate oxygen and nutrients and that waste products are removed.[ii] However, blood pressure uniformity may change significantly during surgery. This complication is called haemodynamic instability, manifested by drops in blood pressure, and known as intraoperative hypotension (IOH). Hypotension is the medical term for abnormal drops of blood pressure in the blood vessels and it is a common side effect of general anaesthesia, affecting up to 99% of patients.[iii], [iv]
“Haemodynamic management needs to be a key part of the early curriculum for surgeons and anaesthetists. Not only that, but we need to also target established clinicians and improve their practice.”
A single minute of IOH during surgery can cause serious harm[v], but most patients are not aware of this dangerous issue. Moreover, increased hospitalisation and hospital stay associated with IOH are likely to have a significant economic impact on European healthcare systems. However, if haemodynamic instability is effectively monitored and prevented, these complications can be avoided and patient outcomes significantly improved.
What can clinicians do?
Join us on the call to hear recommendations from the ImPrOve Think Tank on how to reduce haemodynamic instability, including through enhancing clinical education. Haemodynamic management needs to be a key part of the early curriculum for surgeons and anaesthetists. Not only that, but we need to also target established clinicians and improve their practice. By improving awareness and education among clinicians, we can help ensure adherence to and implementation of new European guidelines on blood circulation during surgery.
Secondly, it is important that clinicians involve patients and their families in an open dialogue about the risks of poor blood circulation, so they are invested in the actions taken by the perioperative team to ensure the best outcomes and safety before, during and after surgery.
Seán Kelly, MEP
Why did you decide to support the ImPrOve Think Tank?
Over 2.4 million patients in Europe undergo high-risk surgery every year.[vi], [vii] Recent data from a UK study suggested that 80% of postoperative deaths occur in a 10% sub-population of high-risk patients, and if this trend continued at a European level, potentially 192,000 would die in the 30-day period after surgery.i
“From a policymaker perspective, as well as the obvious benefit for patient safety and quality of life, improving blood circulation during surgery has a very substantial cost benefit for our healthcare systems”
From a policymaker perspective, as well as the obvious benefit for patient safety and quality of life, improving blood circulation during surgery has a very substantial cost benefit for our healthcare systems. Hospitals are under increasing pressure, both financially and from a substantial backlog due to COVID-19. Therefore, European healthcare needs innovative and smart solutions to ensure optimal patient safety and cost savings, which is why I decided to support the ImPrOve Think Tank’s important cause.
From a policy perspective, what can be done to help improve patient safety?
There are two main things that policymakers can do to help improve patient safety. The first is to secure new funding sources for hospitals to invest in innovative digital monitoring technologies, such as advanced haemodynamic monitoring, to help maintain stable blood circulation during surgery. Second, it is important that we support initiatives like the ImPrOve Think Tank by recognising the value of patient safety data generated by innovative digital monitoring technologies in health data policies.
Ms Luciana Valente International Relations Manager at SIHA (Senior International Health Association)
Why is the ImPrOve Think Tank’s work so important for patients?
It is predicted that by 2050, one in four people will be over 65 in the EU[viii] , increasing pressure on healthcare systems and clinicians with a growing number of complex surgical procedures. We therefore believe that haemodynamic instability will be a likely and growing cause of a significant proportion of modifiable postoperative mortality and morbidity in Europe. Patients have a right to the highest standard of perioperative care, including the latest advanced haemodynamic monitoring technology needed to improve health outcomes after surgery.
“Patients […] should be informed that no surgery is without risk, but reassured that actions, such as the use of advanced haemodynamic monitoring technology, can be taken to mitigate risks”
How can patients ensure optimal patient safety and care in the perioperative process?
Patients often take a passive role in discussions around their surgical procedure and assume they are safe. However, they should be informed that no surgery is without risk, but reassured that actions, such as the use of advanced haemodynamic monitoring technology, can be taken to mitigate risks. To ensure the best outcomes and safety before, during and after surgery, patients should be actively involved in dialogue about the risks of poor blood circulation, what will be done to prevent it, and implications of any complications observed during the procedure.
Ultimately, improving patient safety means better outcomes of surgery and quality of life, quicker recovery and less time spent in hospital and ICU.
The ImPrOve Think Tank is an independent multidisciplinary pan-European group who aim to mobilise key stakeholders such as clinicians, policymakers and patients in their quest to improve patient safety across Europe, specifically focusing on IOH (intraoperative hypotension). Help to bring this issue out from the shadows and join a panel of European critical care experts, patients, and policy makers for a one-hour webinar on 28th September. For more information and to sign-up to the launch webinar, please visit: www.improvethinktank.org
This article is sponsored by Edwards Lifesciences, who also provided financial support to the ImPrOve Think Tank. The ImPrOve Think Tank’s discussions in the European Report and calls to action were undertaken independently of industry and the group is currently looking for additional sponsors to enable them to continue their vital work long-term.
[i] Minto et al. Continuing Education in Anaesthesia, Critical Care & Pain. 2014; Feb; 1(14):12-17
[ii] British Heart Foundation. How a Healthy Heart Works.
[iii] Wesselink et al. IOH and the risk of postoperative adverse outcomes. Br J Anaesth. 2018 Oct;121(4):706-721.
[iv] Bijker et al. Incidence of IOH as a Function of the Chosen Definition. Anesthesiology. 2007; Aug;107(2):213-20.
[v] Salmasi et al. Relationship between IOH and AKI and AMI after Noncardiac Surgery. Anesthesiology. 2017 Jan;126(1):47-65.
[vi] Preoperative Score to Predict Postoperative Mortality – POSPOM Edward’s Presentation
[vii] Ghaferi et al. Variation in Hospital Mortality Associated with Inpatient Surgery. N Engl J Med, 2009.
[viii] United Nations. Ageing. 2019.
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This article reflects the views of the author and not the views of The Parliament Magazine or of the Dods Group