A large UK study found that a relatively small group of surgical…
A large UK study found that a relatively small group of surgical patients classified as high risk account for around four out of five deaths within 90 days after surgery.
These patients also contribute to over half of hospital bed days and close to one third of emergency readmissions, despite being fewer than one in ten operations.
The findings support earlier identification of risk and stronger specialist perioperative care for older people and those living with multiple long term conditions.
A major analysis led by Queen Mary University of London has highlighted how strongly surgical outcomes are concentrated among people at highest risk.
Published in The Lancet Public Health, the study examined what happens to patients after surgery across the UK and found that a relatively small proportion of high risk patients account for the majority of serious outcomes in the months after their operation.
The researchers point out that the NHS carries out around five million surgical procedures each year.
Within that total, roughly 300,000 procedures are performed on people considered high risk. Despite being a minority of cases, this group accounted for four out of five deaths within 90 days after surgery.
They also represented over half of all hospital bed days and nearly one third of emergency readmissions.
The study challenges a simplistic view that poor outcomes are mainly about what happens in the operating theatre.
The researchers suggest that many complications are driven by the realities of older age, frailty, and multiple long term health conditions, rather than technical failings in surgery or anaesthesia.
That points to a need to do more before and after the procedure, not only during it.
One message is about timing and honesty.
The authors argue that high risk patients should be identified earlier and offered care that is tailored to their individual needs.
They also emphasise the importance of open conversations between clinicians and patients about the expected benefits, the risks, and what recovery might look like over months rather than just the first few weeks.
Another message is about services.
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The findings support investment in specialist perioperative teams that focus on high risk patients before, during, and after surgery. This includes optimising chronic conditions, improving fitness and nutrition where possible, planning postoperative support, and spotting complications early.
This research is one of the largest UK analyses of surgical outcomes.
It used health records from 13 million adults and covered 16.1 million surgical procedures across England, Scotland, and Wales between 2015 and 2019.
For people living with diabetes, the relevance is direct – diabetes is a common long term condition among surgical patients and can affect infection risk, wound healing, and recovery, especially when combined with heart disease, kidney disease, or frailty.
If you are preparing for surgery, it is reasonable to ask what your individual risk looks like, how your diabetes will be managed around the procedure, and what support is in place after discharge.