title: Review article: improving outcome after major surgery: pathophysiological considerations.
abstract: Surgical and anesthesia-related techniques may reduce physical stress for patients undergoing high-risk surgery, but major surgery is increasingly performed in patients with substantial comorbidities. Strategies for improving the outcome for such patients include approaches that both increase tissue oxygen delivery and reduce metabolic demand. However, these strategies have produced conflicting results. To understand the success and failure of attempts to improve postoperative outcome, the pathophysiology of perioperative hemodynamic, metabolic, and immunological alterations should be analyzed. Our aim in this review is to provide a survey of fields of opportunities for improving outcome after major surgery. The issues are approached from 3 different angles: the view of the patient, the view of the surgical intervention, and the view of the anesthesia. Special attention is also given to what could be considered the result of the interaction among the 3: perioperative inflammation and immune response.
authors.affiliation: Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, and University of Bern, Bern CH-3010, Switzerland.
authors.forename: Vanessa M
authors.initials: VM
authors.lastname: Banz
authors.forename: Stephan M
authors.initials: SM
authors.lastname: Jakob
authors.forename: Daniel
authors.initials: D
authors.lastname: Inderbitzin
mesh_terms: D000758:Anesthesia / Q000009:adverse effects; D015897:Comorbidity; D004734:Energy Metabolism; D006439:Hemodynamics; D006801:Humans; D007107:Immune System / Q000276:immunology / Q000503:physiopathology; D011183:Postoperative Complications / Q000209:etiology / Q000378:metabolism / Q000503:physiopathology / Q000517:prevention & control*; D018570:Risk Assessment; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000009:adverse effects*; D016896:Treatment Outcome