Improving the care for elective surgical patients: post-operative ICU admission and outcome

Surgery has been defined by the World Health Organization (WHO) as an “essential component of health care worldwide and often the only therapy that can alleviate disabilities and reduce the risk of death from common conditions” (1,2). Surgery plays an important role in addressing a diverse set of cross-cutting health challenges delivered by multidisciplinary team of specialists (3). However, surgery implies in its nature an aggressive invasion of the boundaries (4) of the body which may be associated with life-threatening complications and impaired quality of life (5). Furthermore, according to previous reports, 5 billion people are unable to access safe and affordable surgical and anaesthetic care (6-8). Safe surgery has been considered a public health priority (9) and many efforts have been invested to outline the best strategy to be undertaken for the sake of surgical patients. An epidemiological analysis conducted by the International Surgical Outcomes Study (ISOS) (10) group enrolled 44,814 patients in 27 (19 high-, 7 middle-, and 1 low-income) countries worldwide. A total 16.8% rate of complications was detected: infections were the most frequent, followed by cardiovascular and bleeding events. The overall mortality rate after surgery was 0.5%, nevertheless, it sharply rode at 2.8% in case of post-operative complications. Conversely, of the 9.7% patients admitted to a critical care unit immediately after surgery, 50.4% developed a complication with a 2.4% death rate