Identifying risks is futile without evaluations of risk reduction

BMJ 1995;311:628 (2 September)

Letters

Identifying risks is futile without evaluations of risk reduction

EDITOR,--N Mamode and colleagues conclude that all surgeonsshould have a protocol for investigating patients who seem tobe at risk of a myocardial infarction perioperatively.¹ Evenif it was possible to identify or quantify the risk accurately,however, there is little point in the exercise unless effectivestrategies exist for managing patients at risk. Many of themeasures that can be undertaken to minimise risk--for example,control of hypertension and diabetes; weight loss; cessationof smoking; and, in particular, the avoidance of perioperativehypoxia and hypotension--should be routine in the managementof all patients. Similarly, invasive monitoring of arterialand central venous pressure is routine in major operations,while insertion of pulmonary artery catheters has not been provedto have a beneficial effect on outcome.² Intensive care shouldbe provided for all patients undergoing repair of an aorticaneurysm or operation of similar magnitude but, given the excessof . . . [Full text of this article]

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