Managing perioperative risk in patients undergoing elective non-cardiac surgery

The perioperative care of patients undergoing major surgery is increasingly recognised as an area that substantially affects public health and for which needs are poorly met. Around 15% of people who undergo inpatient surgery are at high risk of complications, such as pneumonia or myocardial infarction, because of age, comorbid disease, or the complexity of the surgical procedure.1 2 High risk surgical patients account for 80% of all perioperative deaths. Non-cardiac surgery is an important cause of death and disability, owing to the high volume of procedures and related adverse outcomes.1 2 3 4 5 6 Around 250 million major surgical procedures are performed worldwide each year.3 This number is increasing as gross domestic product rises in poorer countries.3 Assuming a hospital mortality rate of 1%, non-cardiac surgery will be associated with 2.5 million deaths worldwide each year and complication rates at least five times this figure.1 2 3 4 5 6 Patients who survive postoperative complications commonly experience functional limitations and reduced long term survival.4 5 6

Varying mortality rates between hospitals indicate the potential and the need to improve survival after surgery.7 However, the reasons for the variation in mortality are not fully understood, making effective planning more …