Healthier Together

‘Nearly 1500 lives over 5 years’


Right care, Right place, Right time - saving lives

The definition of General surgery is surgery performed on your abdomen (stomach and bowel) aka "your tummy".

In some cases with this type of surgery sometimes something can go wrong and you may need emergency general surgery for conditions like peritonitis.

General surgery also includes major operations for serious bowel conditions such as cancer.

Although these types of surgery are not that common and most of us will never need to have them - they can be risky.

Most people recover well but complications after surgery can happen and they need to be spotted and treated quickly. And in some cases patients may need another operation.

Unfortunately some people die following this type of major surgery. Many survive but with life changing complications.

Fact: in 2012 – 2013, 537 people died after these kinds of operations in Greater Manchester.

Fortunately there are standard steps that can be followed to reduce risks.

Here are some examples of ways we can improve standards:

  • Ensuring that patients can have urgent tests like scans done, no matter what time of day or night it is so that poorly patients get the correct urgent treatment they need.
  • Making sure that you are cared for in an intensive care ward after surgery so that you will be checked more regularly than on a normal ward. So that if anything does start to go wrong it will be spotted and treated quickly. 
  • Being treated by specialists aka consultants who are experts in this type of surgery to ensure that patients are given the best chance of a good recovery.

Doctors and nurses in Greater Manchester have described over 300 standards that we ned to meet to make sure that patients needing this type of surgery are cared for. If we follow these standards, we know that the chance of dying is reduced and so is the risk of developing complications.

Unfortunately, as things are, these standards are not followed every time in every hospital that does general surgery. This means that in some hospitals the risk of dying or developing life changing complications is higher than in others.

Dr Foster is an independent organisation that specialises in analysing health data. Dr Foster looked at how many people died in hospitals in Greater Manchester after these types of general surgery in 2012 - 2013. Dr Foster compared this with the number that would be expected to die based on the number and types of patient in each hospital (This is known as the Standardised Mortality Ratio (SMR) )


They found big differences across Greater Manchester with the risk of dying following this type of surgery being twice as high in hospitals not performing as well as others in Greater Manchester.

This is not acceptable.

Healthier Together aims to ensure that the standards are followed in every hospital.

Dr Foster then looked at how many fewer deaths there might have been after general surgery if all hospitals in Greater Manchester did as well as the best in Greater Manchester and found that the number could be reduced by 151 per year. In the same way, Greater Manchester was compared with the best hospital in the country and it was found that if all hospitals in Greater Manchester did that well there could be 289 fewer deaths after general surgery per year.

If this was projected over 5 years this could mean between 755 and 1445 (nearly 1500) fewer deaths after general surgery in Greater Manchester hospitals. 

How is the potential reduction in deaths calculated?

dr-foster.pngTo do this, Dr Foster looks at the percentage (ratio) of expected deaths that actually happened in the best hospital*. They then used this percentage to estimate out how many of the expected deaths might have happened in the other hospitals if they had as few deaths as the best hospital. This estimate is then compared with the actual number of deaths. The difference between the two numbers shows how many deaths might have been avoided if all hospitals had as few deaths as the best.

*The percentage or ratio is calculated by dividing the actual deaths by the expected deaths.

Want to know more?

There is a lot of national and international evidence about how standards for general surgery can save lives. If you want to know more you can read this evidence:


Royal College of Surgeons of England (2011). Emergency surgery. Standards for unscheduled care.

Royal College of Surgeons of England (2011). The higher risk general surgery patient. Towards improved care for a forgotten group.

Saunders et al (2012). Variations in mortality after emergency laparotomy. The first report of the UK emergency laparotomy network.

British Journal of Anaesthesia 109(3): 368-75.

Symons et al (2013). Mortality in high risk general surgical admissions.

British Journal of Surgery 100 (10): 1318-25.

Ghaferi et al (2009). Variations in hospital mortality associated with inpatient surgery. New England Journal of Medicine 361: 1368-75.

Almoudaris et al (2011). Value of the failure to rescue as a marker of the standard of care following reoperation for complications after colorectal resection. British Journal of Surgery 98(12): 1775-83.


See also


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