The UK needs more critical care investment in order to improve peri‐operative outcomes

The National Confidential Enquiry into Patient Outcome and Death (NCEPOD) recently launched a report on peri-operative care [1]. Featuring prominently in the report are data comparing mortality for patients undergoing major non-cardiac surgery in the UK and USA over the same time period in comparable hospitals. The authors noted that in patients with a 0-5% mortality risk as predicted using the Portsmouth modified Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (P-POSSUM), actual UK mortality rates are eight times that of the US (2.5% vs. 0.3%, respectively); and in patients with a P-POSSUM predicted mortality risk of 11–20%, UK mortality rates are almost three times that of the USA (14.9 vs. 5.3%, respectively) [1, 2]. The authors rightly assert that the NHS can and must improve peri-operative management of high-risk patients. However, comparing mortality rates between the UK and USA in this way is not a like-for-like comparison. Healthcare spending in the USA is significantly more per capita (US$6719 (£4358; €5193)) than in the UK (US$3332 (£2161; €2575) – 15.3% vs. 8.2%, respectively, when expressed as a percentage of each country’s GDP [3]. Furthermore, the USA has 20 intensive care beds per 100 000 population compared with just 3.5 per 100 000 in the UK [4]. Currently, the NHS does not have the same level of investment to achieve the admirable outcomes of our US counterparts. As well as improved pre-operative assessment and intra-operative care, a central message of the NCEPOD report is that the NHS needs to invest in more critical care beds to improve outcomes in high risk surgical patients. Such an expansion would potentially require major building or structural work, expensive new equipment and significantly increased nursing and medical staffing. In the current austere climate, with the NHS budget facing increasing financial difficulties, it seems unlikely that investment in such an expensive care modality will increase in the near future.