Death After Surgery May Be More Common Than We Think

A European study shows surgery deaths may be twice as high as expected.

September 20, 2012, 7:43 PM

Sept. 21, 2012— -- In 2006, an otherwise healthy 53-year-old Ezekiel C. Mobley Jr. underwent routine surgery to remove an infected appendix. A Los Angeles native, he was planning to get back to hosting Pittsburgh's first Spanish-speaking television show. But he died before leaving the hospital.

"I was really shocked -- very, very shocked," said Ora Mobley Sweeting, a human rights activist and Mobley's mother. "Why did this happen to my son?"

A veteran with a master's degree from both Harvard University and the London School of Economics, Mobley passed away from unexpected complications after surgery because of "technology," Sweeting said.

"I don't know what that meant."

Though cases like this are rare, they do happen. The most recent data available suggests that in the U.S., 1.14 percent of patients who go in for surgery never leave the hospital.

But a new study on surgery death rates in Europe, published Thursday in the journal Lancet, may have medical experts wondering whether this figure isn't higher in the U.S.

Researchers in the United Kingdom looked at more than 46,000 patients in 28 European countries who underwent non-cardiac surgery.

They found that 4 percent of them died before they could make it out of the hospital, a figure much higher than previous national estimates for many countries.

In the UK alone, the death rate was 3.6 percent; the previous estimate was 1 percent.

The surgery death rates that the researchers found in other countries ranged from Latvia, which at 21.5 percent had the worst death rate, to Iceland with a rate of 1.2 percent.

"[The findings] highlight the urgent need for national and international strategies to improve care for this group of patients," said lead study author Rupert Pearse from Queen Mary, University of London.

As to whether a study similar to the Lancet research done in the U.S. would reveal the death rate to be higher than this, experts were split. While some said the death rates here would be half that in Europe, given strict regulations in the U.S., others said death rates in American operating rooms might well rival those across the Atlantic.

"Compared to overall [death rates], the U.S. is probably better, but compared to [certain] individual countries, we're probably worse," said Dr. David Penson, director of the Center for Surgical Quality and Outcomes Research at the Vanderbilt Institute of Medicine and Public Health. "When it comes to quality of care, we are not at the front of the line, but we're not at the back either."

Even conducting a study like this one in the U.S. would be a challenge, said Dr. Michael West, professor of surgery at UC-San Francisco General Hospital and Trauma Center.

"It's extraordinarily difficult to 'compare apples to apples' within the U.S. health care system," he said.

The Lancet study also found that nearly 75 percent of patients in Europe who died did not get admitted to an intensive care unit (ICU), a factor that could have been responsible for higher death rates there.

"Ideally, everyone would be monitored in an ICU-type environment until ready for discharge," said Dr. Howard Nearman, anesthesiologist-in-chief at University Hospitals Case Medical Center, in Cleveland. "Obviously, that is expensive, impractical, and probably not needed."

Even so, the intensive care unit may not be the answer to all the problems.

"When ICU resources are made more widely available, they are often misused or misapplied," said Dr. Anthony Smith, professor of surgery/urology at the University of New Mexico School of Medicine.

Regardless, doctors said, the findings serve as a reminder that constant reevaluation is needed when it comes to life-and-death medical services.

"The goal should be quality improvement at every level," said Dr. Jonathan Gates, trauma surgeon at Brigham and Women's Hospital, in Boston, and member of Best Doctors, Inc.

Focusing on improving quality of care may be a logical step given that the United States spends more money on health care than any other country in the world.

Perhaps it could have helped prevent what happened to Ezekiel Mobley six years ago.