Epidemiology of the high-risk population: perioperative risk and mortality after surgery.

PURPOSE OF REVIEW: This review will provide an overview of actual data concerning perioperative risk. Furthermore, strategies to prevent, detect and treat perioperative complications will be discussed.

RECENT FINDINGS: Perioperative in-hospital mortality rate of 0.4-4% has not improved over the last years possibly resulting in one to several million deaths during or immediately after surgery each year worldwide. Perioperative complications and mortality are determined not only by the type of surgery but also by preexisting comorbidities of the patient. However, most potentially lethal complications have a slow onset like surgical site infections, pneumonia and sepsis. Therefore, a time window of opportunity might exist to detect and treat these complications as well as to improve outcome. In this context, failure to rescue (FTR) has been introduced as an indicator for the quality of perioperative care. There is growing evidence that FTR is a relevant phenomenon in perioperative medicine, possibly accounting for almost half of postoperative mortality.

SUMMARY: It is imperative to reliably identify patients at risk for postoperative complications and to implement strategies into clinical practice allowing for prevention, early detection and effective treatment of complications. By bundling best practice concepts in all phases of perioperative care, patient outcome will be effectively improved.