Skip to main content Accessibility help
×
Hostname: page-component-848d4c4894-5nwft Total loading time: 0 Render date: 2024-05-24T15:02:23.682Z Has data issue: false hasContentIssue false

3 - Postoperative management

Published online by Cambridge University Press:  15 December 2009

Douglas M Bowley
Affiliation:
Department of Colorectal Surgery, John Radcliffe Hospital, Headington, Oxford, UK
Andrew N. Kingsnorth
Affiliation:
Derriford Hospital, Plymouth
Aljafri A. Majid
Affiliation:
Derriford Hospital, Plymouth
Get access

Summary

INTRODUCTION

Outcomes after surgery are influenced by:

  • preoperative physiological status,

  • operative severity,

  • 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 Society 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.

The Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) was developed in 1991. POSSUM variables include physiological markers and other factors related to operative severity. These variables have been tested extensively and have resulted in a central database of over 200,000 patients. POSSUM scoring has been used to predict the outcome of patients undergoing a broad range of operations and has been recognized as being the most appropriate available score for assessing risk in surgical patients. However, POSSUM over-predicts mortality for those patients at the low-risk end of the spectrum. The Portsmouth group revised the scoring and the so-called P-POSSUM is now widely used.

Operative severity

Surgery (or trauma from injury) has been shown to result in immune suppression and organ failure is the leading cause of death in surgical patients.

Type
Chapter
Information
Publisher: Cambridge University Press
Print publication year: 2006

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×