Letters

Reducing the risk of major elective surgery

BMJ 1999; 319 doi: https://doi.org/10.1136/bmj.319.7221.1369a (Published 20 November 1999) Cite this as: BMJ 1999;319:1369

Paper should have given details on causes of death

  1. S Sudhindran, specialist registrar (sudhindran@bigfoot.com)
  1. Royal Liverpool University Hospital, Liverpool L7 8XP
  2. Royal Prince Alfred Hospital, Camperdown, Sydney, Australia
  3. University of New South Wales, St George Hospital, Kogarah, Sydney
  4. Guys and St Thomas's NHS Trust, Guy's Hospital, London SE1 9RT
  5. Department of Anaesthesia and Intensive Care, Ipswich Hospital NHS Trust, Ipswich IP4 5PD
  6. Department of Anaesthetics, York District Hospital, York YO31 8HE

    EDITOR—Does the result of Wilson et al's trial from a district general hospital justify routine preoperative administration of inotropes and fluids to all patients having major elective surgery?1 Detailed mortality data, in particular on the cause of death, are lacking in their results, surprisingly. The morbidity data show that there was a significantly increased rate of surgical complications in the control group compared with the study group (seven of the 46 patients in the control group developed surgical complications (four cases of anastomotic breakdown and three of deep haemorrhage) compared with four of the 92 in the study group (all cases of deep haemorrhage); P=0.04).

    If any of these surgical complications were the direct cause of death in the controls then the effectiveness of the preoperative regimen in the study group in reducing mortality becomes ambiguous. This would be particularly pertinent with regard to the two late deaths in the control group, since these deaths are unlikely to have been due to inadequate preoperative optimisation of oxygen delivery. The use of 4.5% albumin and of red cell transfusion below a blanket threshold haemoglobin concentration of 110 g/l is a controversial issue.24

    References

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    Better management of intensive care unit beds is necessary

    1. Imogen Mitchell, staff specialist in intensive care,
    2. David Bihari, associate professor of critical care medicine (d.bihari@unsw.edu.au)
    1. Royal Liverpool University Hospital, Liverpool L7 8XP
    2. Royal Prince Alfred Hospital, Camperdown, Sydney, Australia
    3. University of New South Wales, St George Hospital, Kogarah, Sydney
    4. Guys and St Thomas's NHS Trust, Guy's Hospital, London SE1 9RT
    5. Department of Anaesthesia and Intensive Care, Ipswich Hospital NHS Trust, Ipswich IP4 5PD
    6. Department of Anaesthetics, York District Hospital, York YO31 8HE

      EDITOR—Wilson et al's randomised controlled trial in high risk surgical patients goes some way to showing the benefits of intensive care1—a service hopelessly underfunded and therefore underused in the United Kingdom. This low priority in the United Kingdom is highlighted yet again in the study, by the 16 patients in the control group who did not receive intensive or high dependency care immediately after their high risk surgery despite beds being available.

      It is hard to know if the small heterogeneous groups in the study were matched for severity of illness, skill of the surgeon and anaesthetist, and volume of blood transfused. All …

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