Queen Mary University Unveils Landmark Study on Post-Surgery Mortality

A groundbreaking study led by researchers at Queen Mary University of London has revealed that high-risk surgical patients, comprising fewer than one in ten cases, account for nearly 80% of all post-surgery deaths within 90 days across the UK. Published in The Lancet Public Health in March 2026, this comprehensive analysis of over 13 million adults and 16 million surgical procedures from 2015 to 2019 underscores the urgent need for enhanced perioperative care strategies within the National Health Service (NHS). Perioperative medicine, which encompasses the medical care provided from the time a patient is prepared for surgery through to their recovery, plays a pivotal role in mitigating these risks.

The research, spearheaded by the Critical Care and Perioperative Medicine Research Group (CCPMG) at Queen Mary in partnership with Barts Health NHS Trust, highlights how an aging population and rising multimorbidity are driving up the volume of high-risk surgeries to approximately 300,000 annually. This finding not only spotlights a major public health challenge but also positions Queen Mary University as a leader in advancing surgical outcomes research.

Methodology: Analyzing Vast NHS Datasets for Precision Insights

The study utilized routine NHS data from Hospital Episode Statistics in England, Scottish Morbidity Records, and the Patient Episode Database for Wales, linking to national death registries for comprehensive follow-up. Researchers included adults aged 18 and over undergoing non-obstetric inpatient or day-case surgeries between 2015 and 2019, totaling 12.9 million patients and 16.1 million procedures.

High-risk patients were identified using a multivariable logistic regression model predicting 90-day mortality risk, incorporating factors such as age, sex, admission type (elective vs. non-elective), procedure risk score, frailty (via Hospital Frailty Risk Score), and Charlson Comorbidity Index (CCI). The threshold for high-risk was set at the top decile capturing 80% of deaths (≥3.43% risk), with moderate-risk (next 15%) and low-risk (bottom 5%) for comparison. The model's C-statistic of 0.94 demonstrated excellent predictive accuracy.

This rigorous, retrospective cohort approach allowed for real-world insights into long-term outcomes, including 5-year survival, hospital length of stay (LOS), readmissions, and bed-day utilization.

The Scale of High-Risk Surgery in the UK

High-risk procedures represented 9.2% of all surgical spells (1.48 million), rising from 8.5% in 2015 to 10% in 2019, reflecting demographic shifts. With over five million surgeries performed yearly in the NHS, this equates to around 300,000 high-risk cases annually—double the 166,000 estimated in a 2006 study.

Overall 90-day mortality stood at 1.6% (262,500 deaths), but high-risk patients bore 80% of these. At one year, 4% of patients died (644,596), with high-risk accounting for a disproportionate share. These figures emphasize that while surgery is safer than ever, high-risk cohorts drive the majority of perioperative mortality.

Demographic Profile and Comorbidities of High-Risk Patients

High-risk patients averaged 75.2 years old (SD 12.1), with 53.3% men and 81.5% White ethnicity. Over 71% were non-elective admissions, and 87% required inpatient stays. Frailty was prevalent (40.1% moderate or high), and only 10.4% had no CCI comorbidities compared to 75.8% in low-risk groups.

• Cardiac failure: 22.3%
• Respiratory disease: 30.3%
• Cancer: 30.2%
• Dementia: 11.9%
• Chronic kidney disease: 21.1%

These profiles illustrate a vulnerable group where chronic conditions amplify surgical risks, often leading to complications like myocardial infarction or pneumonia.

For those exploring careers in managing such cases, Queen Mary's research jobs in perioperative medicine offer opportunities to contribute to patient-centered advancements.

Mortality and Survival Rates: A Stark Contrast

One in seven high-risk patients died within 90 days, one in four by one year, and nearly two-thirds by five years. Relative risks were dramatically higher: 117 times for 90-day mortality compared to low-risk. Median days alive and out-of-hospital at 90 days was 78 for high-risk versus 90 for low-risk.

Resource Burden: High-Risk Patients Dominate NHS Usage

Despite comprising just 9.2% of procedures, high-risk patients consumed 53.8% of bed-days (21 million out of 39 million), had median LOS of 10 days (IQR 3-21), and accounted for 28.3% of emergency readmissions (30.9% rate). This strain exacerbates NHS pressures, particularly amid rising demand.

Read the full Lancet study for detailed tables on outcomes.

Implications for Shared Decision-Making and Patient Care

Lead researcher Professor Rupert Pearse emphasized: "While surgery is safer than ever before, high-risk patients are more likely to have poor outcomes... It is vital that we work to improve care... including having open conversations about individual risk." Dr. Tom Abbott added: "The decision to have surgery is a choice each individual should make... understanding the benefits as well as the risks."

The study advocates shifting beyond 30-day survival metrics to include long-term quality of life, palliative options, and value-based care.

Perioperative Medicine: Key to Improving High-Risk Outcomes

Specialist perioperative services—prehabilitation, optimized anesthesia, and post-op monitoring—have shown promise in reducing complications. The NHS's Getting It Right First Time (GIRFT) National Perioperative Care Programme standardizes these, with early screening and health optimization recommended for elective surgeries.

• Pre-operative risk assessment and optimization
• Multidisciplinary teams for frail patients
• Enhanced recovery protocols
• Palliative integration where surgery risks outweigh benefits

Queen Mary's MSc in Anaesthesia and Perioperative Medicine equips professionals for these roles.Learn how to advance your career in this field.

Queen Mary University's Leadership in Perioperative Research

The CCPMG drives innovation through clinical trials, data science, and global health initiatives. Partnerships with Barts Health enable translational research from lab to bedside, influencing NHS policy. Programs like the MSc prepare nurses, doctors, and operating department practitioners for perioperative pathways.

Explore university jobs at institutions like Queen Mary to join such impactful teams.

Broader NHS Context and Recent Developments

UK lifetime surgery risk is around 60%, with perioperative mortality improving but high-risk groups lagging. Recent GIRFT efforts and Royal College of Anaesthetists initiatives aim to expand services, though variation persists. In 2025-2026, emergency surgery mortality reductions (e.g., 24% in some trusts) highlight targeted interventions' potential.

Medical Xpress coverage provides further expert insights.

Future Outlook: Policy, Research, and Workforce Needs

As high-risk volumes grow, policy must prioritize perioperative investment, societal debates on surgery versus alternatives, and research into personalized predictions. Queen Mary's ongoing trials promise further breakthroughs.

For aspiring researchers, opportunities abound in faculty positions focusing on surgical outcomes.

Photo by Nadzeya Matskevich on Unsplash

Career Pathways in Perioperative Medicine and Research

This study exemplifies the value of academic research in healthcare. Queen Mary's programs and CCPMG offer training for lecturer and professor roles. Check higher ed jobs, lecturer jobs, and professor jobs to contribute.

In conclusion, rate professors via Rate My Professor, explore higher ed jobs, and access higher ed career advice for success.