SQUEEZE Study
Latest news
Publication is available in Open Access at British Journal of Anaesthesia
BJA Editorial on SQUEEZE Study
The SQUEEZE Study is one of the largest international collaborations in perioperative medicine, exemplifying the remarkable achievements our specialty can realise through cross-border cooperation. We extend our sincere appreciation to all national coordinators and local investigators for their invaluable contributions, particularly during the challenging COVID-19 pandemic.
What we discovered
Massive hospital-to-hospital differences
Some hospitals gave blood pressure medications to only 1 in 100 patients after surgery, while others gave them to 1 in 8 patients. This 18-fold variation couldn’t be explained by how sick patients were, what operations they had, or whether the hospital was in a rich or poor country.
Clinical judgment vs. technology
Most doctors decided whether to give these medications based on their clinical assessment rather than using cardiac output monitoring. There is a gap between what we’re taught to do and what actually happens in practice.
Culture matters more than resources
The variation in Vasopressor use appeared equally in wealthy and developing countries, suggesting that hospital culture and individual doctor preferences drive treatment decisions more than medical evidence or available resources.
Agreement on what, not when
Interestingly, while hospitals disagreed dramatically about when to give blood pressure medications, they mostly agreed on which medication to use: norepinephrine was the clear favorite worldwide.
What does it mean
For patient care: When identical patients receive different treatments based solely on which hospital they visit, it raises important questions about quality and consistency of care.
For healthcare systems: Improving postoperative care consistency requires changing professional behavior and institutional culture, not just purchasing new equipment.
For medical education: The gap between guidelines and practice highlights opportunities for better training and standardized protocols.
What’s next?
Several substudies are already planned using the SQUEEZE database. This will allow us to examine more aspects of perioperative treatments, postoperative vasopressor use and patient outcomes.
Collaborative research opportunities: Every SQUEEZE collaborator has the opportunity to propose and lead additional substudies using the SQUEEZE dataset. For authorship questions, please refer to the “Authorship Policy“
If you’re interested in proposing a substudy or learning more about research opportunities with the SQUEEZE database, please contact the study team at squeeze@esaic.org.
Chief Investigators
- Dr Ib Jammer (Haukeland University Hospital – Bergen, Norway)
- Dr Ben Creagh-Brown (Royal Surrey County Hospital NHS Foundation Trust – Guildford, United Kingdom)
Steering Committee
Lui Forni (UK), Ramani Moonesinghe (UK), Hannah Wunsch (Canada) and Peter Martin (UK).
Sponsor
The Study was entirely sponsored by a grant from the ESAIC CTN.