ETHER: a proposal for a European peri-operative data sharing and registry network

An initiative from the ESAIC perioperative database working group

Author: Shruthi Madappa (ESAIC)

Peri-operative care—covering the period before, during, and after surgery—remains a cornerstone of modern healthcare. Despite major advances, complications during this phase continue to drive morbidity, mortality, and healthcare costs. A key limitation in addressing these challenges is not a lack of data but an inability to use it effectively. Across Europe, electronic patient record (EPR) systems generate vast amounts of clinical information, yet fragmentation, lack of standardisation, and limited interoperability prevent this data from being leveraged at scale.

The ETHER initiative (European peri-operative data sharing and registry network), proposed by the European Society of Anaesthesiology and Intensive Care (ESAIC), aims to solve this problem. Its core idea is straightforward but powerful: build a collaborative, Europe-wide data-sharing network that integrates peri-operative clinical data, monitoring data, and outcomes into a unified, continuously updated registry. This would enable large-scale research, benchmarking, and real-time improvements in patient care.

Why this matters now

The fundamental issue is scale. Many perioperative complications are rare, sometimes occurring in as few as 1 in 10,000 cases. Detecting meaningful patterns, risk factors, or treatment effects in such scenarios requires datasets involving hundreds of thousands of patients. Single institutions or even national datasets often lack sufficient volume and diversity. As highlighted in the article, identifying even a twofold increase in rare adverse events may require datasets of approximately 600,000 patients.

At the same time, healthcare is moving toward personalised and data-driven decision-making, often powered by artificial intelligence. Without access to large, diverse, and high-quality datasets, these innovations remain limited or biased. ETHER is positioned as a critical enabler for this next phase of healthcare evolution.

What ETHER aims to achieve

The proposed network goes beyond simple data aggregation. It is designed as a collaborative ecosystem involving hospitals, researchers, industry partners, and policymakers. Its key objectives include:

• Improving patient outcomes through large-scale outcomes research
• Enabling benchmarking across hospitals and clinicians
• Supporting policy evaluation with real-world evidence
• Facilitating clinical trials, including low-cost embedded trials within routine care
• Driving innovation, especially AI-based decision support tools

By pooling data across Europe, ETHER would allow clinicians and researchers to answer questions that are currently impossible or prohibitively expensive to study.

A detailed publication on this initiative has now been published in the European Journal of Anaesthesiology—read it here: [link]

Fig 1: Logo for ETHER, the European peri-operative data sharing and registry network.

Fig 2 – Proposed road map for establishing the ETHER network between 2026 and 2030