Excellent anaesthesia needs patient preparation and postoperative support to influence outcome.
OBJECTIVE
Studies over many years have demonstrated that preoptimization and attention to appropriate perioperative care is associated with a substantial decrease in surgical mortality. This review discusses ways in which patient preparation and perioperative support can minimize surgical mortality and morbidity.


RESULTS
Scoring systems continue to be developed in order to classify categories of surgical risk. Objective physiologically based assessments can also identify high-risk groups of patients. Debate continues over the indications for specific interventions such as beta-blockade or statin therapy. There is continuing interest in perioperative optimization of oxygen delivery. A multimodality approach paying attention to a range of possible interventions appears to be beneficial. Audit, training, experience and a sufficient volume of procedures are all factors associated with surgical mortality.


CONCLUSIONS
The provision of a high-quality service throughout the perioperative period is vital for a successful outcome. Patients need to be assessed well before major elective surgery to determine if they fall into a high-risk category. Some patients may benefit from a change in management. Postoperatively, critical-care support should be available backed by level 1 (enhanced ward) care with input from outreach or medical emergency teams 24 hours per day, seven days a week.
Goldhill
David
D
The Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK. David.Goldhill@rnoh.nhs.uk
Waldmann
Carl
C
D001014:Aortic Aneurysm / Q000601:surgery; D001794:Blood Pressure / Q000502:physiology; D002302:Cardiac Output / Q000502:physiology; D003106:Colon / Q000601:surgery; D006801:Humans; D009204:Myocardial Revascularization; D020380:Needs Assessment / Q000191:economics*; D019990:Perioperative Care / Q000191:economics* / Q000458:organization & administration*; D018570:Risk Assessment; D016896:Treatment Outcome