Improving post-operative morbidity and mortality

Cusack, R. J., Ball, J. A.S., Rhodes, A. and Grounds, R. M. (2002) Improving post-operative morbidity and mortality. Intensivmedizin und Notfallmedizin, 39 (7), 571-577. (doi:10.1007/s00390-002-0336-1).

Abstract

In certain groups of patients the risk of peri-operative death can be as high as 35% with up to 80% these deaths occurring in patients who develop post-operative multiple organ dysfunction syndrome (MODS). Patients at increased risk of death are easily identifiable prior to surgery. This is achieved by various objective methods of assessing the patient's physiological reserve and severity of pathological insult inflicted. Improving or optimising tissue perfusion and oxygenation during the peri-operative period can reduce this excess mortality. Adequate fluid resuscitation is the essential first step in maximising cardiac contraction and cardiac output leading to improved tissue perfusion. This is followed by the cautious use of inotropes if required. However, the beneficial effects of increased cardiac output needs to be carefully balanced against the increased myocardial oxygen demand with inotrope use. Although these interventions have an associated cost with increased attention required from medical staff and increased use of monitoring equipment, in reality not only is a reduction in mortality and complications seen in optimised patients but also a reduction in intensive care stay and hospital length of stay, resulting in an overall lower cost of treatment. Despite the large individual patient benefit and the financial savings associated with optimising high-risk surgical patients, many hospitals 'lack adequate facilities' or foresight to institute these preventative measures.

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Contributors

Author: R. J. Cusack

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