New report calls for recovery units to boost surgery survival rates

June 23, 2005

Hospitals could improve survival rates following major surgery by streamlining their critical care units, according to a new report launched today at a London conference. As well as saving lives, hospitals could save an estimated £2 million each by implementing some of the report's key recommendations to help reduce hospital stay times.

The report, "Modernising Care for Patients Undergoing Major Surgery", argues that a simple set of measures could reduce the number of complications following surgery along with the average length of hospital stay. Measures such as 'fast-tracking' more patients through intensive care units (ICU) and using exercise to assess and improve patients' fitness could also improve overall mortality rates, currently around 20,000 deaths per year out of the 3 million surgical operations performed.

The Improving Surgical Outcomes Group behind the report, led by consultants from University College London (UCL), St George's Hospital, Ipswich Hospital, University College London Hospital and Lewisham Hospital, says that at present an estimated one per cent of NHS patients undergoing major surgery go on to ICU or high dependency units (HDU), where evidence suggests that around 35 per cent of patients would benefit from a HDU setting and around 15 per cent require an ICU. The report recommends introducing post-surgery overnight recovery units into more hospitals.

The report also recommends the adoption of methods like cardio-pulmonary exercise testing (CPX), not commonly used at present within the NHS, as more reliable methods of assessing a patient's fitness and associated risks for surgery. For some patients, the risk of death following surgery is greater than the risk of death from the underlying condition.

Some patients who suffer from dehydration go on to develop complications. The report argues that this can be avoided with fluid and electrolyte replacement procedures and a process known as haemodynamic optimisation, where the anaesthetist administers a mix of fluids guided by monitored cardiac output. At present, while these procedures are standard in some hospitals, many others do not make use of them. Nutritional supplements can also improve patients' outcome along with exercise.

Overall the report recommends:The costs of implementing these measures would be marginal compared with the potential savings, argues the report. For example, CPX testing is no more expensive than many current tests which are poor at predicting actual risk. For haemodynamic optimisation, the potential savings in terms of reduced hospital stays are estimated for an average NHS trust to be over £2 million. Recent studies conducted at York Hospital and St George's Hospital showed that these interventions reduced the number of hospital bed days by up to 40 per cent.

A handful of hospitals already operate post-surgery units, such as St Thomas's Hospital where over 12,000 patients have had overnight post-surgery critical care. The new University College London Hospital just opened on Euston Road will house another such facility, combining an Extended Recovery Area with a Post-Anaesthesia Care Unit.

The UK has a lower proportion of hospital beds dedicated to critical care compared to many other countries, although the number of ICU beds is increasing in the UK. On average, there are 0.6 critical care beds per 10,000 population in England compared with 4.4 per 10,000 in the US. One study comparing a UK and US hospital found a four-fold higher level of observed mortality in the UK following surgery.

Monty Mythen, Professor of Anaesthesia and Critical Care at UCL, says: "The recommendations of our report can be delivered with existing resources and involve mainly a shift in priorities over how budgets related to surgery are allocated.

"The effect of major surgery on the energy reserves of a patient is equivalent to running a half-marathon for a fit person, which is why it is crucial to assess a patient's fitness for surgery. We're proposing, for example, that instead of running complicated body scans, doctors can use much simpler, more reliable fitness tests at no extra cost."
-end-


University College London

Related Critical Care Articles from Brightsurf:

Six ways primary care "medical homes" are lowering health care spending
New analysis of 394 U.S. primary care practices identifies the aspects of care delivery that are associated with lower health care spending and lower utilization of emergency care and hospital admissions.

New strategies suggested for critical heart care in the ICU
Critically ill heart patients are at increased risk of complications that are potentially preventable and associated with death, longer hospital stays and higher costs.

Capital funding of health care in Canada is critical, yet declined in last 20 years
Capital funding of health care, used to build new hospitals, redesign or upgrade existing facilities and invest in new technologies, has declined in Canada over the last 20 years, according to an analysis in CMAJ (Canadian Medical Association Journal) http://www.cmaj.ca/lookup/doi/10.1503/cmaj.191126.

Mortality of mechanically ventilated COVID-19 patients is lower than previously reported reveals study in Critical Care Medicine
An online first study published in Critical Care Medicine indicates the actual mortality rate of adults with critical illness from COVID-19 is less than what was previously reported.

COVID-19 critical care bed modelling study: potential shortage in Canada
A national modelling paper predicting the number of available ICU beds across Canada during the COVID-19 pandemic suggests that self-isolation will likely not be enough to keep demand from exceeding supply.

Covid-19 tool allows health leaders to plan for critical care surge
The challenges of COVID-19 will require hospital leaders, practitioners and regional officials to adopt drastic measures that challenge the standard way of providing care.

Critical care surgery team develops blueprint for essential operations during COVID-19
To help guide hospital surgery departments through this crisis, the acute surgery division at Atrium Health's Carolinas Medical Center in Charlotte, N.C., has developed a tiered plan for marshaling limited resources.

Study: Critical care improvements may differ depending on hospital's patient population
A new study led by researchers at Beth Israel Deaconess Medical Center reveals that while critical care outcomes in ICUs steadily improved over a decade at hospitals with few minority patients, ICUs with a more diverse patient population did not progress comparably.

Study finds disparity in critical care deaths between non-minority and minority hospitals
While deaths steadily declined over a decade in intensive care units at hospitals with few minority patients, in ICUs with large numbers of minority patients, there was less improvement, according to new research published online in the American Thoracic Society's American Journal of Respiratory and Critical Care Medicine.

Hospital critical care resuscitation unit improves patients' chances of survival
Patients with acutely life-threatening health conditions who were treated in the innovative Critical Care Resuscitation Unit (CCRU) received faster treatment and had better health outcomes, including a 36 percent lower risk of dying than those who were transferred from a hospital's emergency department then evaluated and treated in a traditional intensive care unit, according to a recent study in the Journal of Emergency Medicine conducted by researchers at the University of Maryland School of Medicine.

Read More: Critical Care News and Critical Care Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.