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14 - Caring for surgical patients: complications and communication

Published online by Cambridge University Press:  03 May 2011

Douglas M. Bowley
Royal Centre for Defence Medicine, Birmingham
Andrew Kingsnorth
Derriford Hospital, Plymouth
Douglas Bowley
Heart of England NHS Foundation Trust
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‘Every surgeon carries about him a little cemetery, in which from time to time he goes to pray. A cemetery of bitterness and regret, of which he seeks the reason for certain of his failures.’

La Philosophie de la Chirurgie. René Leriche, 1879–1955


Surgery creates a unique relationship between patient and practitioner. The impact of serious illness, particularly cancer, and the surgery required to treat it may impose lifelong physical and psychological burdens. These consequences are unlikely to be confined to the individual, as the patient's family and even wider society may be affected.

Establishment and maintenance of trust and the relationship of care between a surgeon and his or her patients facilitates the necessary physical and psychological transitions after major surgery. Optimal outcomes depend on this relationship as well as good preoperative preparation, optimum surgery and meticulous postoperative management.

Outcomes after surgery are influenced by:

  • preoperative physiological status

  • operative severity and

  • the provision of appropriate care.

Surgeons can minimize the deleterious effects of the surgical insult by careful preoperative planning, meticulous intraoperative technique and by accurate postoperative care.

Preoperative physiological status

Preoperative co-existing medical problems translate into increased operative risk. The simplest tool to assess patient risk factors is the American Association of Anesthetists (ASA) scale. This is a subjective assessment of the patient's operative risk based on the presence and severity of co-existing medical problems, which are detected by routine history and physical examination. Increasing ASA grade correlates with increased risk of postoperative complications.

Fundamentals of Surgical Practice
A Preparation Guide for the Intercollegiate MRCS Examination
, pp. 230 - 247
Publisher: Cambridge University Press
Print publication year: 2011

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Annane, Det al. Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock. JAMA 2002;288:862–871.CrossRefGoogle ScholarPubMed
Arriaga, AFet al. The Better Colectomy Project: association of evidence-based best-practice adherence rates to outcomes in colorectal surgery. Ann Surg 2009;250(4):507–513.Google ScholarPubMed
Bennett-Guerrero, Eet al. Comparison of P-POSSUM risk-adjusted mortality rates after surgery between patients in the USA and the UK. Br J Surg 2003;90(12):1593–1598.CrossRefGoogle ScholarPubMed
Bernard, GRet al. Efficacy and safety of recombinant human activated protein C for severe sepsis. N Engl J Med 2001;344:699–709.CrossRefGoogle ScholarPubMed
Bruce, Jet al. Systematic review of the definition and measurement of anastomotic leak after gastrointestinal surgery. Br J Surg 2001;88(9):1157–1168.CrossRefGoogle ScholarPubMed
Ellis, Het al. Adhesion-related hospital readmissions after abdominal and pelvic surgery: a retrospective cohort study. Lancet 1999;353:1476–1480.CrossRefGoogle ScholarPubMed
Hebert, PCet al. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group. N Engl J Med 1999;340(6):409–417.CrossRefGoogle ScholarPubMed
Mangano, DTet al. Effect of atenolol on mortality and cardiovascular morbidity after noncardiac surgery. Multicentre Study of Perioperative Ischaemia Research Group. N Engl J Med 1996;335:1713–1720.CrossRefGoogle ScholarPubMed
Poldermans, Det al. The effect of bisoprolol on perioperative mortality and myocardial infarction in high-risk patients undergoing vascular surgery. N Engl J Med 1999;341:1789–1794.CrossRefGoogle ScholarPubMed
Berghe, Get al. Intensive insulin therapy in the critically ill patients. N Engl J Med 2001;345(19):1359–1367.CrossRefGoogle ScholarPubMed
Williamson, LMet al. Serious hazards of transfusion (SHOT) initiative: analysis of the first two annual reports. BMJ 1999;319(7201):16–19.CrossRefGoogle ScholarPubMed

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