A major new study led by Queen Mary University of London has revealed a worrying truth about surgery outcomes in the United Kingdom. The research, published in The Lancet Public Health, examined millions of operations carried out by the National Health Service (NHS).
Every year, about five million surgical procedures take place across the NHS. For most people, surgery is now very safe and often the best way to treat serious illness or injury.
However, the study found that around 300,000 of these operations are performed on patients who are considered high‑risk, and these patients experience far more problems after surgery than others.
The researchers discovered that within 90 days after surgery, high‑risk patients account for four out of five deaths. They also use more than half of all hospital bed days and nearly one‑third of emergency readmissions.
This means that although they make up less than one in ten surgical patients, they carry most of the burden when things go wrong. The findings suggest that hospitals need to pay much closer attention to this smaller group of vulnerable people.
High‑risk patients are often older adults who live with several long‑term health problems such as heart disease, lung disease, diabetes, or kidney problems. Many are also frail, meaning their bodies are weaker and take longer to recover from stress. The study showed that poor outcomes are usually not caused by mistakes during surgery or problems with anesthesia.
Instead, complications often happen afterward, when the body struggles to heal or existing illnesses become worse. For example, an older patient with heart disease may develop breathing problems or infections that keep them in hospital for a long time.
The researchers believe that doctors need to identify high‑risk patients much earlier and provide care that is specially designed for their needs before, during, and after surgery. This type of care is known as perioperative care.
It includes preparing patients in advance, managing their chronic illnesses carefully, and supporting recovery for months after the operation. Better planning may help reduce complications and improve quality of life.
Professor Rupert Pearse, an intensive care specialist at Queen Mary University of London and Barts Health NHS Trust, explained that surgical safety has improved greatly over the years. Even so, high‑risk patients are still much more likely to suffer harm after surgery compared with low‑risk patients.
As populations age and more people live longer with chronic illnesses, the number of high‑risk patients is expected to grow. He emphasized the importance of honest conversations between doctors and patients so individuals can understand the risks and benefits before deciding whether to have surgery.
For decades, surgical success was often judged by whether patients survived the first 30 days after an operation. This study shows that this short time frame does not tell the whole story.
Many high‑risk patients face serious problems weeks or months later, including long hospital stays and reduced independence. Looking at longer‑term outcomes could help doctors make better decisions and reduce pressure on hospitals.
Dr. Tom Abbott, a co‑lead author and specialist in anesthesia and perioperative medicine, said that modern surgery has saved and improved millions of lives. However, choosing to have surgery should always be a personal decision made after fully understanding the possible benefits and risks.
For some people, the dangers may outweigh the advantages, especially if their health is already fragile. Health organizations such as the Royal College of Anaesthetists are now working to improve services so high‑risk patients receive the tailored support they need.
This study is one of the largest ever conducted in the UK on surgical outcomes. It analyzed health records from 13 million adults who underwent 16.1 million operations in England, Scotland, and Wales between 2015 and 2019.
The scale of the research provides strong evidence that better planning and long‑term care could save lives and improve recovery for thousands of patients every year.
The message from the research is clear. Surgery itself has become safer, but the journey after surgery can still be dangerous for people who are older, frail, or living with chronic illness.
By identifying these patients early and supporting them throughout the entire process, healthcare systems may be able to prevent many deaths and reduce suffering. This approach could also ease the heavy pressure on hospitals by reducing long stays and emergency readmissions.
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