Perioperative mortality

Perioperative mortality is mortality in 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 disease and pulmonary disease are both associated with poor outcome of surgery.

Intraoperative
Complications during surgery, e.g. hemorrhage or perforation of organs may have lethal sequelae.

Infection
Local infection of the operative field is prevented by asepsis (using sterile materials), and prophylactic antibiotics are 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 thrombosis and pulmonary embolism, which is prevented by the administration of low molecular weight heparins and compression stockings, and cyclical pneumatic calf compression in very high risk patients.

Hypostatic pneumonia
Physiotherapy has a place in preventing pneumonia due to shallow inspirations, which occurs especially in patients recovering from abdominal surgery. Early treatment with antibiotics may be necessary.

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

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 tables that 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.