The burden of high-risk surgery and the potential benefit of goal-directed strategies

摘要: The survey by Cannesson and colleagues [1] in the previous issue of Critical Care shows that only around 16% anesthetists (5.4% 210 US respondents 30.4% 158 European respondents) use a specific treatment protocol (that is, follow goal-directed strategy) for peri-operative hemodynamic management patients undergoing high-risk surgery. In 2008, Weiser [2] estimated global volume surgery to be 234.2 million procedures year. According Pearse [3], surgical represent 12.5% this total. A meta-analysis 29 randomized controlled trials investigating value strategies reported an average mortality rate 9.4% control groups significantly reduced 5.9% when strategy was adopted [4]. When putting all pieces puzzle together, one can estimate 860,000 lives could potentially saved every year (the equivalent life 37 seconds) if such became standard care world (Table ​(Table11). Table 1 Estimates potential worldwide benefit strategies In addition, millions post-operative complications avoided. Indeed, Hamilton [4] suggests complication from 29.8% 18.0% with strategies. Given after ​(Table1),1), direct costs treating these as well indirect related prolonged hospital length stay are difficult quantify precisely but without question astronomically high. It may time heath-care systems governments consider part quality improvement programs national priorities.