Multimodal strategies to improve surgical outcome

Objective: To evaluate the effect of modifying perioperative care in noncardiac surgical patients on morbidity, mortality, and other outcome measures. Background: New approaches in pain control, introduction of techniques that reduce the perioperative stress response, and the more frequent use of mi...

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Bibliographic Details
Published in:The American Journal of Surgery 2002-06, Vol.183 (6), p.630-641
Main Authors: Kehlet, Henrik, Wilmore, Douglas W
Format: Article
Language:English
Subjects:
Abdomen
Abstinence
Alcohol
Analgesics
Anesthesia
Anesthesia, Epidural
Anesthesia, General
Antibiotics
Biological and medical sciences
Complications
Drug dosages
Epidural
Evaluation
Fast track surgery
General anesthesia
Hospitalization
Humans
Improved outcome
Insulin resistance
Laparoscopy
Medical personnel
Medical sciences
Metabolism
Miscellaneous
Morbidity
Mortality
Narcotics
Outcome Assessment (Health Care)
Pain
Patient Discharge
Patient Satisfaction
Patients
Perioperative care
Postoperative
Postoperative Care
Postoperative Complications - prevention & control
Postoperative period
Preoperative Care
Regional anesthesia
Rehabilitation
Risk Factors
Stress, Psychological
Surgery
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgical outcomes
Surgical Procedures, Operative - psychology
Surgical Procedures, Operative - rehabilitation
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Summary:Objective: To evaluate the effect of modifying perioperative care in noncardiac surgical patients on morbidity, mortality, and other outcome measures. Background: New approaches in pain control, introduction of techniques that reduce the perioperative stress response, and the more frequent use of minimal invasive surgical access have been introduced over the past decade. The impact of these interventions, either alone or in combination, on perioperative outcome was evaluated. Methods: We searched Medline for the period of 1980 to the present using the key terms fast track surgery, accelerated care programs, postoperative complications and preoperative patient preparation; and we examined and discussed the articles that were identified to include in this review. This information was supplemented with our own research on the mediators of the stress response in surgical patients, the use of epidural anesthesia in elective operations, and pilot studies of fast track surgical procedures using the multimodality approach. Results: The introduction of newer approaches to perioperative care has reduced both morbidity and mortality in surgical patients. In the future, most elective operations will become day surgical procedures or require only 1 to 2 days of postoperative hospitalization. Reorganization of the perioperative team (anesthesiologists, surgeons, nurses, and physical therapists) will be essential to achieve successful fast track surgical programs. Conclusions: Understanding perioperative pathophysiology and implementation of care regimes to reduce the stress of an operation, will continue to accelerate rehabilitation associated with decreased hospitalization and increased satisfaction and safety after discharge. Developments and improvements of multimodal interventions within the context of “fast track” surgery programs represents the major challenge for the medical professionals working to achieve a “pain and risk free” perioperative course.
ISSN:0002-9610
1879-1883
DOI:10.1016/S0002-9610(02)00866-8