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High-risk surgery: epidemiology and outcomes

High-risk surgery: epidemiology and outcomes
High-risk surgery: epidemiology and outcomes
Surgical morbidity is a significant public health issue worldwide. It is estimated that >230 million surgical procedures are performed each year, with an estimated mortality of at least 0.4% and morbidity of between 3% and 17%. Furthermore, there are potentially far-reaching consequences of a complicated perioperative course, because perioperative morbidity is associated with reduced long-term survival. In this review, we examine the factors that are associated with surgical outcomes. Issues related to the delivery of health care, such as structure, process, and resource utilization, have been shown to vary within and between institutions, leading to differences in both morbidity and mortality after surgery. Patient-related factors, in particular comorbid illness, functional capacity, and cardiovascular health, are also related to perioperative risk, and may be assessed using risk stratification models, exercise testing, and biomarker assays. The strengths and weaknesses of each of these techniques are discussed. We also review the strengths and limitations of the measures used to assess outcome after surgery, including patient-centered variables such as mortality and morbidity scores, and patient-related outcome measures. Finally, we suggest the direction of future work, which should be aimed at improving the precision of tools for describing perioperative risk, and of the measures used to assess the outcomes and quality of surgical health care. These tools are the building blocks of high-quality clinical trials, epidemiological studies, and quality improvement programs
0003-2999
891-901
Moonesinghe, Suneetha Ramani
4deeef03-dc8e-46b5-b019-adc7410e05df
Mythen, Michael Gerard
72c46c10-78cc-4890-86a2-1ec66b5d8f1c
Grocott, Michael Patrick William
1e87b741-513e-4a22-be13-0f7bb344e8c2
Moonesinghe, Suneetha Ramani
4deeef03-dc8e-46b5-b019-adc7410e05df
Mythen, Michael Gerard
72c46c10-78cc-4890-86a2-1ec66b5d8f1c
Grocott, Michael Patrick William
1e87b741-513e-4a22-be13-0f7bb344e8c2

Moonesinghe, Suneetha Ramani, Mythen, Michael Gerard and Grocott, Michael Patrick William (2011) High-risk surgery: epidemiology and outcomes. Anesthesia and Analgesia, 112 (4), 891-901. (doi:10.1213/?ANE.0b013e3181e1655b). (PMID:20495138)

Record type: Article

Abstract

Surgical morbidity is a significant public health issue worldwide. It is estimated that >230 million surgical procedures are performed each year, with an estimated mortality of at least 0.4% and morbidity of between 3% and 17%. Furthermore, there are potentially far-reaching consequences of a complicated perioperative course, because perioperative morbidity is associated with reduced long-term survival. In this review, we examine the factors that are associated with surgical outcomes. Issues related to the delivery of health care, such as structure, process, and resource utilization, have been shown to vary within and between institutions, leading to differences in both morbidity and mortality after surgery. Patient-related factors, in particular comorbid illness, functional capacity, and cardiovascular health, are also related to perioperative risk, and may be assessed using risk stratification models, exercise testing, and biomarker assays. The strengths and weaknesses of each of these techniques are discussed. We also review the strengths and limitations of the measures used to assess outcome after surgery, including patient-centered variables such as mortality and morbidity scores, and patient-related outcome measures. Finally, we suggest the direction of future work, which should be aimed at improving the precision of tools for describing perioperative risk, and of the measures used to assess the outcomes and quality of surgical health care. These tools are the building blocks of high-quality clinical trials, epidemiological studies, and quality improvement programs

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More information

Published date: April 2011
Organisations: Human Development & Health

Identifiers

Local EPrints ID: 348906
URI: http://eprints.soton.ac.uk/id/eprint/348906
ISSN: 0003-2999
PURE UUID: 6cdc794c-7745-4c17-a4eb-8542f24e0399
ORCID for Michael Patrick William Grocott: ORCID iD orcid.org/0000-0002-9484-7581

Catalogue record

Date deposited: 22 Feb 2013 08:44
Last modified: 15 Mar 2024 03:33

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Contributors

Author: Suneetha Ramani Moonesinghe
Author: Michael Gerard Mythen

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