Department of Anaesthesia, Austin Health, Victoria, Australia.
Best Pract Res Clin Anaesthesiol. 2011 Sep;25(3):319-27. doi: 10.1016/j.bpa.2011.05.003.
Recent publications not only underline the risks of age and disease during surgery but also help us quantify the risks with greater precision. Importantly, patient factors often have a stronger association with postoperative mortality than surgical factors. Important factors preoperatively are: age, American Society of Anaesthesiologist (ASA) physical status, emergency surgery, and plasma albumin concentration. There is emerging work on quantifying frailty as a further risk factor for perioperative complication and mortality as well as need for higher level of care after discharge from hospital. Important postoperative complications include sepsis and kidney injury. Preventing, detecting and managing complications and mortality is the greatest challenge facing those caring for surgical patients, including anaesthetists. Evidence for the long term effects of perioperative complications adds further importance to minimizing perioperative complications. Newer approaches in patient care, particularly co-management during the postoperative phase by different specialities are emerging. Managing high-risk patients should also be enhanced with greater surveillance and more rapid and appropriate response; ensuring we do not fail to rescue our patients.
最近的出版物不仅强调了手术期间年龄和疾病的风险，还帮助我们更精确地量化这些风险。重要的是，患者因素通常与术后死亡率的关系比手术因素更为密切。术前的重要因素包括：年龄、美国麻醉医师协会（ASA）身体状况、急症手术和血浆白蛋白浓度。目前有越来越多的工作致力于将脆弱性量化为围手术期并发症和死亡率的进一步风险因素，以及出院后需要更高水平的护理。重要的术后并发症包括败血症和肾损伤。预防、检测和处理并发症和死亡率是照顾手术患者（包括麻醉师）面临的最大挑战。围手术期并发症的长期影响的证据进一步强调了将围手术期并发症最小化的重要性。新的患者护理方法，特别是在术后阶段由不同专业共同管理的方法正在出现。对高危患者的管理还应通过更严密的监测以及更快和更适当的反应来加强；确保我们不会未能抢救我们的患者。
