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Critical Care  2013 

Can surgical outcomes be prevented by postoperative admission to critical care?

DOI: 10.1186/cc11687

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Abstract:

It has been estimated that up to 230 million surgical procedures are performed each year in the world [6]. If we consider patients undergoing non-cardiac surgery, up to 4% may die [7], and a significant portion more will develop postoperative complications [8] with a prolonged duration of hospital stay and a reduced longer-term survival [3]. Although for the majority of surgical patients, the risks of complications are low, for a significant number this is not the case [9,10]. In major surgery, even in groups with a low mortality rate, the incidence of post-operative complications is disproportionately high. The identification of risk for these patients is not straight-forward. Important factors can be grouped into one of a number of main categories: first, those that are present prior to surgery that include the co-morbid status and age of the patient and the type and urgency of the surgery performed and, second, the physiological derangement of the patient at the end of the surgical procedure [10]. Many other strategies and markers of physiological status are currently being examined in order to identify the risks involved and to better prioritize available resources to individual patients [11].It has been estimated that in the UK 12% of all patients undergoing surgery account for almost 80% of all complications and deaths [12]. These figures from 2006 were recently confirmed within the UK together with the suggestion that this pattern is also prominent in many other European countries [7]. Clearly, better identification of this group of patients would enable evidence-based, resource-rich strategies to be directed toward this needy group who would be most likely to benefit. Patients are not receiving homogenous standards of care to identify and minimize the perioperative risk; even more, when complications occur, data suggest that different health-care systems react in different ways, leading to very different outcomes [5].One strategy would be to admit all postop

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