Are we operating as well as we can? Critical care to minimise postoperative mortality and morbidity

Mortality and postoperative care after emergency laparotomy

“…The median duration of hospital stay for patients who survived was 11 days (range 2-188, IQR [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20], and for non-survivors 4.5 days (range 1-40, IQR 2-12).…”

“…1 A recent paper and accompanying editorial highlighted the problem of critical care bed access for patients following high-risk non-cardiac surgery. 8,9 Although inadequate provision of beds, funding and resources were cited as causes, these may be compounded by an underestimation, by both surgeons and anaesthetists, of the mortality associated with such surgery.…”

Emergency surgery in the elderly patient: a quality improvement approach

“…Postoperative complications are associated with a particularly high mortality in patients aged 80 years and over [6,7,12,13]. We have UK reports to acknowledge that postoperative care is an area to target [29,30], especially as many high-risk patients are managed outwith a high .............................................................................................................................................................................................................. [14,30,31]. In a more recent study [32], Ghaferi et al found that the difference between hospitals with high and low surgical mortality was not in the incidence or degree of postoperative complications sustained, but the way in which the patients were managed or 'rescued' when these complications occurred.…”

Triage of high-risk surgical patients for intensive care

“…There are no universal criteria for postoperative admission of patients to the ICU. In a recent editorial, Goldhill and Down observed that postoperative critical care is highly inconsistent, with some groups of patients routinely admitted to the ICU postoperatively and others rarely admitted [35]. In some hospitals, patients are admitted postoperatively simply for monitoring, but it is unclear whether using the ICU for this purpose actually improves postoperative outcomes.…”