Inside Nodus

Putting Things Into Perspective

Piktochart Perspectives

At Nodus Medical we spend every waking hour trying to find new and better ways to help surgeons spend more time doing what they’re best at and getting even better at it. You may wonder what makes us get up fully motivated every morning? Here’s our perspective on why what we do really matters.

Atul Gawande, one of our time’s most prolific authors on surgery, reflected on the history of surgery on the occasion of the 200th anniversary of the New England Journal of Medicine and Surgery and succinctly summarized the rapid advances in surgery since the first use of anesthesia in 18461:

‘But the most striking story of surgery in recent decades is how firmly it has become established as an essential tool for helping people live long and healthy lives. Virtually no one escapes having a condition for which effective treatment requires surgery […]’.

We share this belief in surgery as a great innovation that saves and improves lives. Extrapolating from the latest available research published by the WHO which estimated around 313 million surgical procedures in 20122, in 2018 the number will rise to almost 400 million surgical procedures worldwide. If we look to the US for instance, the average American can expect to undergo more than 9 procedures during his lifetime3!

While these are all very impressive figures that improved and saved countless lives over the past decades, complications and even deaths unfortunately remain far too common. A multicentric study across 28 European countries4 looked at patients undergoing inpatient non-cardiac surgery and reported an overall mortality rate of 4% after surgery – ranging from 3.2% for elective surgery to 9.7% for emergency surgery.

In addition, many more patients will suffer from complications during their stay at the hospital – another study on elective surgery across 27 low-, middle and high-income countries found average complication rates of almost 17%5. What’s even more alarming: around 40% of complications are typically judged to be avoidable6!

Connecting the same dots that Nodus Medical is aiming to connect, the WHO launched its Guidelines for Safe Surgery and the now-famous Surgical Safety Checklist in 2008. The implementation of this checklist across 8 pilot hospitals from a variety of socioeconomic backgrounds led to a reduction in mortality of 47% and in complications of 36%7.

A simple back-of-the-envelope calculation would therefore suggest that up to 6-7 million people will die potentially preventable deaths in 2018. Such a calculation would of course be too simplistic as it doesn’t take into account factors such as the patient’s underlying condition or their expected remaining lifetime. Nevertheless, there’s definitely massive scope for improvement!

As a final thought – especially for the hardened financial warriors out there – the issue at hand isn’t just an issue of saving lives, it’s also an issue of hard dollars (or whatever your chosen currency may be). Whenever a complication happens, we can expect the costs of caring for the patient to more than double8.


That’s definitely something to chew on, isn’t it? Feel free to let us know your thoughts at and follow us on Linkedin to get more content like this.


1.         Gawande A. Two hundred years of surgery. N Engl J Med. 2012;366(18):1716-1723. doi:10.1056/NEJMra1202392

2.         Weiser TG, Haynes AB, Molina G, et al. Size and distribution of the global volume of surgery in 2012. Bull World Health Organ. 2016;94(3):201-209F. doi:10.2471/BLT.15.159293

3.         Lee PHU, Gawande AA. The number of surgical procedures in an American lifetime in 3 states. J Am Coll Surg. 2008;207(3):S75. doi:10.1016/j.jamcollsurg.2008.06.186

4.         Pearse RM, Moreno RP, Bauer P, et al. Mortality after surgery in Europe: a 7 day cohort study. Lancet (London, England). 2012;380(9847):1059-1065. doi:10.1016/S0140-6736(12)61148-9

5.         Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries. Br J Anaesth. 2016;117(5):601-609. doi:10.1093/bja/aew316

6.         Zegers M, de Bruijne MC, de Keizer B, et al. The incidence, root-causes, and outcomes of adverse events in surgical units: implication for potential prevention strategies. Patient Saf Surg. 2011;5:13. doi:10.1186/1754-9493-5-13

7.         Haynes AB, Weiser TG, Berry WR, et al. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med. 2009;360(5):491-499. doi:10.1056/NEJMsa0810119

8.         Healy MA, Mullard AJ, Campbell DAJ, Dimick JB. Hospital and Payer Costs Associated With Surgical Complications. JAMA Surg. 2016;151(9):823-830. doi:10.1001/jamasurg.2016.0773