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Risk of death and surgical interventions

Clinical bottom line

There is a risk of dying with surgical interventions, a risk that can be higher or lower. Very often the risk of dying with surgery is lower than that without surgery, and there are always hoped for benefits that can be important and major.


Data sources

Sources of data were predominantly large surveys or systematic reviews of surveys, or summaries of surveys where similar results were found. A downloadable PDF provides then information.

What the sources tell us

What we get from these studies is the number of deaths and a denominator. What we do not get is any idea of causation.

For example, mortality after a ruptures abdominal aortic aneurysm is pretty close to 100%, and many people will die before getting to hospital. For those we do survive and get to surgery, only 1 in 5 die. Perhaps that is best put the other way, that the vascular surgeons and their teams save 4 out of 5 patients with this condition who get to the operating theatre alive.

On the other hand, for bariatric surgery there is an alternative, or at least the possibility of an alternative, in not eating so much. Patients undergoing bariatric surgery are by their very nature at high risk for bad things happening, and probably give the poor anaesthetists the heeby-jeebies. The fact that only 1 in 270 dies is great news seen from one perspective. It is one risk to be weighted in the balance when deciding on possible treatment choices.

Diagnostic endoscopy done by surgeons has a risk of death of 1 in about 2000 from a Scottish survey. Previous surveys and audits have come up with similar or different results, depending on method (BandoWeb/booth/gi/endoharm.html). Whatever, it is not without risk

Give us the odds

The table below gives a range of interventions with an estimate of the risk of death with each.

Table 1: Risk of death with various surgical interventions


Intervention
Year
Deaths
Population
Odds of dying (1 in )
Surgery for fractured hip - 1 year mortality 1992-2007
22,538
93,391
4
Endovascular Repair of Ruptured AAA 1994-2006
102
484
5
Open Surgery for Colon Cancer 1992-2004
91
586
6
Laparoscopic Surgery for Colon Cancer 1992-2004
67
608
9
Craniotomy 2000
2,054
19,200
9
Esophageal Resection 2000
781
8,585
11
Pancreatic Resection 2000
865
10,416
12
Surgery for fractured hip - 30 day mortality 1992-2007
18,018
236,179
13
Pediatric Heart Surgery 2000
99
1,832
19
Repair of Abdominal Aortic Aneurysm 2000
2,907
74,550
26
Coronary Artery Bypass Graft Surgery 2000
17,804
508,676
29
Carotid Endarterectomy 1985-2004
1,033
84,299
82
Upper GI Endoscopy and Endoscopic Retrograde Cholangiopancreatography 1999
153
35,006
229
Bariatric Surgery 1990-2006
310
84,931
274
Hip Replacement 2000
248
82,680
333
Groin Hernia Repair 1992-2004
496
195,132
393
Laparoscopic Cholecystectomy 1992-1995
20
10,174
509
Upper GI Endoscopy and Endoscopic Retrograde Cholangiopancreatography 1999
20
35,006
1,750

 

Comment

Surgical intervention is not usually undertaken lightly, though often there is little choice involved. Surgical interventions can have absolutely fantastic results. For a small fraction of patients, perhaps with more severe disease, or more risk factors, there is a risk of dying in the immediate period around the operation, though not always necessarily because of the surgery or the anaesthetic (bandolier/band103/b103-3.html). It is useful to know the risk.