December 4, 2015 By Hamilton Spectator, by Joanna Frketich
Too many patients die within 30 days of major surgery, concludes a Hamilton study.
“Almost no one now dies in the operating room or recovery room, but after surgery there is still an appreciable death rate,” said Dr. P.J. Devereaux, principal investigator of the review for the Population Health and Research Institute at McMaster University and Hamilton Health Sciences. “We want to end up changing that outcome.”
Many of the deaths are preventable, found the review published in the New England Journal of Medicine Dec. 3.
“We do believe better testing and much more intensive monitoring on the surgical floors … can allow us to improve the outcomes,” he said.
Every year, about 100 million people age 45 or older have major surgery globally that is not related to the heart. About 1.5 per cent of them die within 30 days of the operation.
The numbers are so high it would rank as the third leading cause of death in the United States, found the study done in partnership with the Cleveland Clinic.
“That’s 1.5 million people,” said Devereaux. “The problem is because surgery is so common even when you talk about 1.5 per cent of people dying that’s still a lot of people. We need to do a better job to get that lower.”
Heart problems cause at least one-third of the deaths following surgery. Part of the reason is the current system does a poor job of identifying those at risk, despite using tests that are costly and require a lot of time and energy.
“The reality is the ability of those tests to predict who is going to get events has limitations,” said Devereaux. “Even though they’re commonly being used, there are serious questions about them. In fact, our research shows you’ll more commonly put someone in the wrong category of risk if you use the test.”
The second problem is that patients aren’t monitored closely enough after surgery.
“The remarkable thing is there are many people walking around on the street who have better monitoring on their wrists than they have on our surgical floors,” he said. “There are all kinds of people whose oxidation is quite low and it’s not known it’s at serious levels and there are people who have low pressure and it’s not recognized for a long time. We need to have a shift from the current model where nurses are checking the vitals every four to eight hours to having smart technology measure this.”
Better monitoring is significant because narcotics given after surgery make it difficult to spot heart problems.
“We typically expect people to get chest pain or shortness of breath,” said Devereaux. “However, 85 per cent of people who get an injury to their heart after surgery won’t get symptoms.”
Two simple blood tests could make a big difference, said Devereaux, who did the study with funding he receives from the Heart and Stroke Foundation of Ontario.
One test done before surgery tells doctors who is at risk of heart problems and one done after identifies those with injury.
“We can measure specific biomarkers in the blood before surgery that so strongly predict who is going to get into trouble after surgery,” said Devereaux. “Simple markers that can be measured in the blood after surgery, allow us to avoid missing important heart injuries.”
Hamilton hospitals often do the blood tests already, but the research aims to convince others to take up the practice as well.
It’s important considering the average age of patients and the risk of heart complications increases each year.