Additional support, expertise, and equipment for general postoperative inpatients

The 1992-3 and 1993-4 national confidential enquiries into perioperative deaths1 2 record the use of monitoring, the availability of facilities, and the experience of the doctors caring for patients. About two thirds of patients died three or more days after surgery, with most of the deaths taking place on a ward. A high percentage of those who died had had a cardiac or respiratory complication, renal failure, or infection, and some of these complications might have been preventable.

Preoperative preparation and a high standard of anaesthetic care are essential, as they affect postoperative events.3 4 By the end of surgery it may be too late to substantially alter outcome for some patients.5 On the other hand, aggressive postoperative optimisation of physiological values has been shown to decrease mortality and morbidity in …