Randomized evidence for reduction of perioperative mortality.
OBJECTIVE
With more than 220 million major surgical procedures performed annually, perioperative interventions leading to even minor mortality reductions would save thousands of lives per year. This international consensus conference aimed to identify all nonsurgical interventions that increase or reduce perioperative mortality as suggested by randomized evidence.


METHODS
A web-based international consensus conference.


METHODS
More than 1,000 physicians from 77 countries participated in this web-based consensus conference.


METHODS
Systematic literature searches (MEDLINE/PubMed, June 8, 2011) were used to identify the papers with a statistically significant effect on mortality together with contacts with experts. Interventions were considered eligible for evaluation if they (1) were published in peer-reviewed journals, (2) dealt with a nonsurgical intervention (drug/technique/strategy) in adult patients undergoing surgery, and (3) provided a statistically significant mortality increase or reduction as suggested by a randomized trial or meta-analysis of randomized trials.


RESULTS
Fourteen interventions that might change perioperative mortality in adult surgery were identified. Interventions that might reduce mortality include chlorhexidine oral rinse, clonidine, insulin, intra-aortic balloon pump, leukodepletion, levosimendan, neuraxial anesthesia, noninvasive respiratory support, hemodynamic optimization, oxygen, selective decontamination of the digestive tract, and volatile anesthetics. In contrast, aprotinin and extended-release metoprolol might increase mortality.


CONCLUSIONS
Future research and health care funding should be directed toward studying and evaluating these interventions.
Department of Anesthesia and Intensive Care, Università Vita-Salute San Raffaele, Milano, Italy, Milan, Italy. landoni.giovanni@hsr.it
Giovanni
G
Landoni
Reitze N
RN
Rodseth
Francesco
F
Santini
Martin
M
Ponschab
Laura
L
Ruggeri
Andrea
A
Székely
Daniela
D
Pasero
John G
JG
Augoustides
Paolo A
PA
Del Sarto
Lukasz J
LJ
Krzych
Antonio
A
Corcione
Alexandre
A
Slullitel
Luca
L
Cabrini
Yannick
Y
Le Manach
Rui M S
RM
Almeida
Elena
E
Bignami
Giuseppe
G
Biondi-Zoccai
Tiziana
T
Bove
Fabio
F
Caramelli
Claudia
C
Cariello
Anna
A
Carpanese
Luciano
L
Clarizia
Marco
M
Comis
Massimiliano
M
Conte
Remo D
RD
Covello
Vincenzo
V
De Santis
Paolo
P
Feltracco
Gianbeppe
G
Giordano
Demetrio
D
Pittarello
Leonardo
L
Gottin
Fabio
F
Guarracino
Andrea
A
Morelli
Mario
M
Musu
Giovanni
G
Pala
Laura
L
Pasin
Ivana
I
Pezzoli
Gianluca
G
Paternoster
Rossella
R
Remedi
Agostino
A
Roasio
Mariachiara
M
Zucchetti
Flavia
F
Petrini
Gabriele
G
Finco
Marco
M
Ranieri
Alberto
A
Zangrillo
D006801:Humans; D038622:Internationality; D019990:Perioperative Care / Q000401:mortality*; D016032:Randomized Controlled Trials as Topic / Q000379:methods / Q000401:mortality*