Shaman Jhanji1, Rupert M Pearse. 1. Barts and The London School of Medicine and Dentistry, Queen Mary's University of London, London, UK.
Abstract
PURPOSE OF REVIEW: The incidence of complications following major surgery is surprisingly high. Patients who develop complications suffer a reduction in long-term survival. This review aims to explore recent advances in the management of surgical patients aimed at preventing postoperative complications. RECENT FINDINGS: Identifying patients prior to surgery who are at risk of a poor outcome remains challenging. There are a number of scoring systems to assist clinical risk assessment. Recent work has investigated the use of plasma biomarkers for perioperative risk prediction. Therapies aimed at reducing complication rates by attempting to improve tissue oxygen delivery include goal-directed haemodynamic therapy and postoperative noninvasive ventilation. The role of perioperative beta-adrenoceptor antagonists remains unclear. Other important measures include the use of a surgical safety checklist and thromboprophylaxis. SUMMARY: Current systems for the identification and treatment of high-risk surgical patients are inadequate. Further research is required to establish the optimal approach to the identification and management of the high-risk surgical patient.
PURPOSE OF REVIEW: The incidence of complications following major surgery is surprisingly high. Patients who develop complications suffer a reduction in long-term survival. This review aims to explore recent advances in the management of surgical patients aimed at preventing postoperative complications. RECENT FINDINGS: Identifying patients prior to surgery who are at risk of a poor outcome remains challenging. There are a number of scoring systems to assist clinical risk assessment. Recent work has investigated the use of plasma biomarkers for perioperative risk prediction. Therapies aimed at reducing complication rates by attempting to improve tissue oxygen delivery include goal-directed haemodynamic therapy and postoperative noninvasive ventilation. The role of perioperative beta-adrenoceptor antagonists remains unclear. Other important measures include the use of a surgical safety checklist and thromboprophylaxis. SUMMARY: Current systems for the identification and treatment of high-risk surgical patients are inadequate. Further research is required to establish the optimal approach to the identification and management of the high-risk surgical patient.
Authors: Federico Coccolini; Francesco Corradi; Massimo Sartelli; Raul Coimbra; Igor A Kryvoruchko; Ari Leppaniemi; Krstina Doklestic; Elena Bignami; Giandomenico Biancofiore; Miklosh Bala; Ceresoli Marco; Dimitris Damaskos; Walt L Biffl; Paola Fugazzola; Domenico Santonastaso; Vanni Agnoletti; Catia Sbarbaro; Mirco Nacoti; Timothy C Hardcastle; Diego Mariani; Belinda De Simone; Matti Tolonen; Chad Ball; Mauro Podda; Isidoro Di Carlo; Salomone Di Saverio; Pradeep Navsaria; Luigi Bonavina; Fikri Abu-Zidan; Kjetil Soreide; Gustavo P Fraga; Vanessa Henriques Carvalho; Sergio Faria Batista; Andreas Hecker; Alessandro Cucchetti; Giorgio Ercolani; Dario Tartaglia; Joseph M Galante; Imtiaz Wani; Hayato Kurihara; Edward Tan; Andrey Litvin; Rita Maria Melotti; Gabriele Sganga; Tamara Zoro; Alessandro Isirdi; Nicola De'Angelis; Dieter G Weber; Adrien M Hodonou; Richard tenBroek; Dario Parini; Jim Khan; Giovanni Sbrana; Carlo Coniglio; Antonino Giarratano; Angelo Gratarola; Claudia Zaghi; Oreste Romeo; Michael Kelly; Francesco Forfori; Massimo Chiarugi; Ernest E Moore; Fausto Catena; Manu L N G Malbrain Journal: World J Emerg Surg Date: 2022-09-21 Impact factor: 8.165
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