Worrying variation in chances of survival after operation between NHS hospitals

The Royal College of Surgeons report found a patient’s chance of survival after a critical operation varied widely between NHS hospitals.

Tens of thousands of patients needing emergency non-cardiac surgery and intensive follow-up treatment are having their lives put at risk by poor NHS care and delays in seeing senior doctors, according to a damning report by the Royal College of Surgeons.

The study found that only a minority of patients who need critical care following surgery receive it, while some die or suffer major complications because of delays in finding space in operating theatres.

It also found that junior staff are often left in charge of dealing with post-surgical complications — which can prove fatal if not treated promptly — and that a patient’s chance of survival varies widely between NHS hospitals, and even within the same hospital depending on the day of the week.

About 170,000 patients have major emergency surgery each year — mostly on the abdomen. Of these, 100,000 will develop significant complications following surgery, resulting in more than 25,000 deaths.

In the UK, fewer than a third of all these patients are admitted to critical care following their surgery, and even those who are admitted tend to stay only 24 hours before being transferred to other wards.

The report said: “Premature discharge from critical care has been identified as an important risk factor for post-operative death, as has delayed admission to critical care.”

On managing complications, it added: “Too often the whole process is slow or inaccurate as it is complex, requires multidisciplinary input, often occurs out of hours and is initiated by junior staff.”

Surgeons leading the study also pointed to “suboptimal care on general wards” as a factor in poor outcomes following surgery.

Research highlighted in the report shows that the chance of a patient dying in a UK hospital is 10% higher if they are admitted at a weekend rather than during the week.

“There were shortfalls in access to theatre, radiology and critical care; surgery was sub-optimally supervised in 30% of cases and there was a failure for juniors to call for help in 21% of cases,” the study went on.

“Timely surgery was not carried out in 22% of patients who died.”

In general, there seems to be a lack of appreciation across the NHS of the level of risk for emergency surgical patients, the report said.

The study says hospitals should provide fast access to operating theatres within defined time periods and prioritise emergency cases over planned surgery wherever necessary.

It may be that separation of planned and unplanned operations is necessary.

Another recommendation is for the highest risk patients to be treated under the direct supervision of consultant surgeons, anaesthetists and intensive care staff, while more needs to be done on access to critical care.

Norman Williams, president of the RCS, said that the focus on reducing waiting times for elective operations had led to a large group of mainly elderly patients finding themselves “under-prioritised to the point of neglect” in some hospitals.

“These changes won’t happen on their own and we are calling on all surgeons and managers to work together to deliver the high-quality care that these patients need and which some hospitals are already proving can be delivered,” he said.

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