Perioperative mortality

Perioperative mortality is mortalityin relation to surgery, usually taken as death within two weeks of a surgical procedure. One of the vital steps in the decision to perform a surgical procedure is to weigh the benefits against the risks. Anaesthestists(and internists) employ various methods in assessing whether a patient is fit for surgery, and various statistical tools are available. Cardiovascular diseaseand pulmonary diseaseare both associated with poor outcome of surgery.

Intraoperative

Complications during surgery, e.g. hemorrhageor perforationof organs may have lethal sequelae.

Postoperative

Infection

Local infection of the operative field is prevented by asepsis(using sterile materials), and prophylacticantibioticsare often given in abdominal surgery or patients known to have a heart defect or mechanical heart valves(that would be more prone to endocarditis).

DVT/PE

Various specific perioperative complications are recognised, and preventive measures are taken. Examples are deep venous thrombosisand pulmonary embolism, which is prevented by the administration of low molecular weight heparinsand compression stockings, and cyclical pneumatic calf compression in very high risk patients.

Hypostatic pneumonia

Physiotherapyhas a place in preventing pneumoniadue to shallow inspirations, which occurs especially in patients recovering from abdominal surgery. Early treatment with antibioticsmay be necessary.

CVA

Cerebrovascular accidentsdo occur at a higher rate during the postoperative period. Few specific measures can be taken to prevent this.

Specific diseases

Liver disease

In patients with cirrhosis, the perioperative mortality is predicted by the Child-Pugh score.

Monitoring

Most hospitals have regular meetings to discuss surgical complications and perioperative mortality. Specific cases may be investigated more closely if a preventable cause has been identified.

In many countries, statistics are kept by mandatory reporting of perioperative mortality. These may then be used in league tablesthat compare the quality of hospitals. Critics of this system point out that perioperative mortality may not reflect poor performance but could be caused by other factors, e.g. a high proportion of acute/unplanned surgery.

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It uses material from the http://en.wikipedia.org/wiki/Perioperative+mortality Wikipedia article Perioperative mortality.