The danger of mapping risk from multiple natural hazards

In recent decades, society has been greatly affected by natural disasters (e.g. floods, droughts, earthquakes), losses and effects caused by these disasters have been increasing. Conventionally, risk assessment focuses on individual hazards, but the importance of addressing multiple hazards is now recognised. Two approaches exist to assess risk from multiple-hazards; the risk index (addressing hazards, and the exposure and vulnerability of people or property at risk) and the mathematical statistics method (which integrates observations of past losses attributed to each hazard type). These approaches have not previously been compared. Our application of both to China clearly illustrates their inconsistency. For example, from 31 Chinese provinces assessed for multi-hazard risk, Gansu and Sichuan provinces are at low risk of life loss with the risk index approach, but high risk using the mathematical statistics approach. Similarly, Tibet is identified as being at almost the highest risk of economic loss using the risk index, but lowest risk under the mathematical statistics approach. Such inconsistency should be recognised if risk is to be managed effectively, whilst the practice of multi-hazard risk assessment needs to incorporate the relative advantages of both approaches

Mortality after surgery in Europe: a 7 day cohort study

Background: Clinical outcomes after major surgery are poorly described at the national level. Evidence of heterogeneity between hospitals and health-care systems suggests potential to improve care for patients but this potential remains unconfirmed. The European Surgical Outcomes Study was an international study designed to assess outcomes after non-cardiac surgery in Europe.Methods: We did this 7 day cohort study between April 4 and April 11, 2011. We collected data describing consecutive patients aged 16 years and older undergoing inpatient non-cardiac surgery in 498 hospitals across 28 European nations. Patients were followed up for a maximum of 60 days. The primary endpoint was in-hospital mortality. Secondary outcome measures were duration of hospital stay and admission to critical care. We used χ² and Fisher’s exact tests to compare categorical variables and the t test or the Mann-Whitney U test to compare continuous variables. Significance was set at p<0·05. We constructed multilevel logistic regression models to adjust for the differences in mortality rates between countries.Findings: We included 46 539 patients, of whom 1855 (4%) died before hospital discharge. 3599 (8%) patients were admitted to critical care after surgery with a median length of stay of 1·2 days (IQR 0·9–3·6). 1358 (73%) patients who died were not admitted to critical care at any stage after surgery. Crude mortality rates varied widely between countries (from 1·2% [95% CI 0·0–3·0] for Iceland to 21·5% [16·9–26·2] for Latvia). After adjustment for confounding variables, important differences remained between countries when compared with the UK, the country with the largest dataset (OR range from 0·44 [95% CI 0·19 1·05; p=0·06] for Finland to 6·92 [2·37–20·27; p=0·0004] for Poland).Interpretation: The mortality rate for patients undergoing inpatient non-cardiac surgery was higher than anticipated. Variations in mortality between countries suggest the need for national and international strategies to improve care for this group of patients.Funding: European Society of Intensive Care Medicine, European Society of Anaesthesiology