Anesthesia, Outcomes, and Public Health

Abstract

More than 50 million surgical procedures are performed annually in the United States, with perioperative complications and related long-term adverse outcomes profoundly affecting the nation's health. A growing number of studies recognize that type of anesthesia, a main determinant of perioperative care, is associated with perioperative morbidity and mortality. Emerging data suggest, for example, that anesthesia may be a determinant of cancer recurrence after surgery. Further research is needed to elucidate the impact of anesthesia-related factors on short- and long-term health outcomes. Progress in this area of medicine and its public-health consequences will depend largely on the interest of the public, researchers, and health care policy makers.

<p>Effects of Anesthesia on Postoperative Recurrence and Metastasis of Malignant Tumors</p>

“…During the perioperative period, many factors affect cancer recurrence, including the immune system, blood transfusions, hypothermia, hyperglycemia, and postoperative pain. [98][99][100] Intact Cell-Mediated Immunity Intact cell-mediated immunity is crucial for developing resistance to tumor metastasis. 101,102 The immune response is regulated by the hypothalamic-pituitary-adrenal axis and the sympathetic nervous system.…”

“…During the perioperative period, many factors affect cancer recurrence, including the immune system, blood transfusions, hypothermia, hyperglycemia, and postoperative pain. 98 – 100 …”

Converting data into information and knowledge: The promise and the reality of electronic medical records

“…The large volume data collection referenced above, made possible by electronic systems, will be crucial in providing data about potential effects of anesthetic choices not only on perioperative morbidity and mortality, but on long-term outcomes as well. [ 11 ] There is now a body of evidence suggesting possible effects of anesthetic choices on cancer recurrence; more robust and comprehensive data from well-designed electronic databases will help convert this from early information about possible associations into practice-changing knowledge. [ 12 ]…”