The use of early intervention to prevent postoperative complications.

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.