BackgroundThere is currently conflicting evidence surrounding the effects of obesity on postoperative outcomes. Previous studies have found obesity to be associated with adverse events, but others have found no association. The aim of this study was to determine whether increasing body mass index (BMI) is an independent risk factor for development of major postoperative complications.MethodsThis was a multicentre prospective cohort study across the UK and Republic of Ireland. Consecutive patients undergoing elective or emergency gastrointestinal surgery over a 4‐month interval (October–December 2014) were eligible for inclusion. The primary outcome was the 30‐day major complication rate (Clavien–Dindo grade III–V). BMI was grouped according to the World Health Organization classification. Multilevel logistic regression models were used to adjust for patient, operative and hospital‐level effects, creating odds ratios (ORs) and 95 per cent confidence intervals (c.i.).ResultsOf 7965 patients, 2545 (32·0 per cent) were of normal weight, 2673 (33·6 per cent) were overweight and 2747 (34·5 per cent) were obese. Overall, 4925 (61·8 per cent) underwent elective and 3038 (38·1 per cent) emergency operations. The 30‐day major complication rate was 11·4 per cent (908 of 7965). In adjusted models, a significant interaction was found between BMI and diagnosis, with an association seen between BMI and major complications for patients with malignancy (overweight: OR 1·59, 95 per cent c.i. 1·12 to 2·29, P = 0·008; obese: OR 1·91, 1·31 to 2·83, P = 0·002; compared with normal weight) but not benign disease (overweight: OR 0·89, 0·71 to 1·12, P = 0·329; obese: OR 0·84, 0·66 to 1·06, P = 0·147).ConclusionOverweight and obese patients undergoing surgery for gastrointestinal malignancy are at increased risk of major postoperative complications compared with those of normal weight.

SummaryIncreasing numbers of patients presenting for surgery are receiving concurrent medication with low-dose aspirin. We surveyed the opinions and working practices of consultant members of the Neuroanaesthesia Society regarding patients who present for elective intracranial surgery whilst taking this form of medication. Identical questionnaires were sent to 140 members of the society and proffered four main questions: (1) the adherence to any policy of stopping aspirin preoperatively, (2) the preferred method of treatment for excessive bleeding in this context, (3) personal knowledge of haemorrhagic complications in this group of patients, (4) the neurosurgical unit concerned. There were 121 responses (86.4%) of which 116 (82.9%) were valid. Of the respondents, 78 (67.2%) were unaware of a written departmental policy for the discontinuation of pre-operative aspirin treatment and had no personal policy. Thirty-two respondents (27.6%) had a personal policy but were unaware of a written departmental policy; only six respondents (5.2%) stated that a written departmental policy was in place. The mean time suggested for discontinuation of aspirin pre-operatively was 11.3 days (range: 1-42 days). Fifty-one respondents (44.0%) considered that patients taking low-dose aspirin were at increased risk of excessive perioperative haemorrhage and 15 (12.9%) anaesthetists reported having personal experience of such problems. Fifty-seven respondents (49.1%) would use a platelet infusion, alone or in association with other blood products or prohaemostatic agents, if haemorrhagic complications developed. The majority of neuroanaesthetists felt that aspirin was a risk factor for haemorrhagic complications associated with intracranial procedures, but most adopt no policy regarding its preoperative discontinuation.Keywords Surgery; neurosurgical. Analgesics; salicylates, aspirin. ...................................................................................... Correspondence to: D. N. James, Department of Anaesthesia, St Thomas' Hospital, Lambeth Palace Road, London SE1 7EH, UK. Accepted: 18 October 1996 Aspirin is increasingly prescribed for its antithrombotic properties [1][2][3][4][5] and more patients are therefore presenting for surgery with dysfunctional circulating platelets. Aspirin is also a common constituent of many 'over the counter ' medications [6].The contribution of low-dose aspirin to increased perioperative blood loss is a contentious issue with conflicting published results from different surgical groups. Data from neurosurgical patients are sparse [7] but aspirin has been identified as an important risk factor in the development of postoperative haematomata following intracranial surgery [8].This survey examined the opinions and working practices of consultant neuroanaesthetists with regard to patients taking low-dose aspirin medication who present for elective intracranial surgery. MethodsIdentical questionnaires with stamped addressed return envelopes were sent to practising consultant members o...

SummaryWe speculated that asymptomatic patients undergoing routine surgery might be at higher risk of subsequent cardiac events. We studied 183 534 patients with no prior admission for heart disease, aged 50-75 years, admitted electively for one of five operations considered medium to low risk of peri-operative cardiac morbidity, between January 1997 and December 2005. Controls were generated from linked records. Within 3 years 3444 (1.9%) patients undergoing operations had subsequent myocardial infarction ⁄ acute coronary syndrome (MI ⁄ ACS) compared with 3708 (2.0%) controls (p < 0.001). Overall 8406 (4.6%) patients undergoing surgery had MI ⁄ ACS compared with 9306 (5.1%) controls (p < 0.001). Of patients undergoing surgery, 20.2% died compared with 25

Background: Patient selection for critical care admission must balance patient safety with optimal resource allocation. This study aimed to determine the relationship between critical care admission, and postoperative mortality after abdominal surgery. Methods: This prespecified secondary analysis of a multicentre, prospective, observational study included consecutive patients enrolled in the DISCOVER study from UK and Republic of Ireland undergoing major gastrointestinal and liver surgery between October and December 2014. The primary outcome was 30-day mortality. Multivariate logistic regression was used to explore associations between critical care admission (planned and unplanned) and mortality, and intercentre variation in critical care admission after emergency laparotomy. Results: Of 4529 patients included, 37.8% (n¼1713) underwent planned critical care admissions from theatre. Some 3.1% (n¼86/2816) admitted to ward-level care subsequently underwent unplanned critical care admission. Overall 30-day mortality was 2.9% (n¼133/4519), and the risk-adjusted association between 30-day mortality and critical care admission was higher in unplanned [odds ratio (OR): 8.65, 95% confidence interval (CI): 3.51e19.97) than planned admissions (OR: 2.32, 95% CI: 1.43e3.85). Some 26.7% of patients (n¼1210/4529) underwent emergency laparotomies. After adjustment, 49.3% (95% CI: 46.8e51.9%, P<0.001) were predicted to have planned critical care admissions, with 7% (n¼10/145) of centres outside the 95% CI. Conclusions: After risk adjustment, no 30-day survival benefit was identified for either planned or unplanned postoperative admissions to critical care within this cohort. This likely represents appropriate admission of the highest-risk patients. Planned admissions in selected, intermediate-risk patients may present a strategy to mitigate the risk of unplanned admission. Substantial inter-centre variation exists in planned critical care admissions after emergency laparotomies.