A talk by Rupert Pearse at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine. All of the conference content can be found here: https://scanfoam.org/ssai2017/ Developed in collaboration between scanFOAM, SSAI and SFAI.

1. Safe, effective surgery:
Everyone’s job
Rupert Pearse
Professor of Intensive Care Medicine
Queen Mary University of London

2. Disclosures
Research Grants
• Nestle Health Sciences
• Edwards Lifesciences
• Intersurgical
• Medtronic
Honoraria
• Nestle Health Sciences
• Edwards Lifesciences
• Medtronic
• Glaxo Smithkline

6. Peri-Operative Medicine....
Prevention and treatment of harm
resulting from the tissue injury of
surgery [and anaesthesia]

7. • 310 million surgical procedures worldwide
• True mortality rate is not known
• 3 million deaths each year

9. ‘Unexplained variation is the
enemy of quality’
W. Edwards Deming

11. Hospital response to the deteriorating patient
Complications Mortality FtR ICU
Ahmad et al. Brit J Anaesth 2017 epub

12. More NHS patients die following
surgery on a Friday

13. The high-risk surgical patient
• Major surgery
• Elderly
• Co-morbid disease
• Emergency surgery

14. Acute harm is characterised by inflammation

15. Inflammation causes
acute organ injury
• Acute kidney injury
• Acute lung injury
• Myocardial injury
• Polyneuropathy & myopathy
• Delirium

17. Hobson C et al. Circulation 2009;119: 2444
Acute Kidney Injury and long-term mortality after
cardiac surgery

18. Acute Kidney Injury:
A key cause of Chronic Kidney Disease
CKD 1
CKD 4
CKD 2
CKD 3
CKD 5 = DIALYSIS
AKI
AKI
AKI
AKI

19. SURGERY
PATIENT
PERI-OPERATIVE CARE
Influencing post-operative complications

20. Before surgery

21. Can we predict poor surgical outcomes?

22. Stenting for obstructing
colorectal cancer

23. Patient Blood Management
Shander A et al. Brit J Anaesth 2012; 109: 55-68.

24. During surgery

25. Use of surgical checklists across Europe
Jammer I et al. Brit J Anaesth 2015; 114: 801-7.

28. Early after surgery

30. Planned ICU admission and mortality
Kahan B et al. Intensive Care Med. 2017; 43: 971-79.

31. Wunsch et al. Anesthesiology 2016; 124: 899-907.
ICU not associated with lower mortality
after surgery in USA

33. Squadrone V et al. JAMA
2005; 293: 589-95.
Control
CPAP

34. Later after surgery

35. Complications decrease long-term survival
Khuri et al. Ann Surg 2005; 242: 326–343

36. Quality of
Life after
surgery in
the UK
Devlin N et al
Govt. report
Hips
Veins Hernias
Knees

37. Surgery as a sentinel event...
• First contact with doctor
• Co-morbid disease
• Secondary prevention

38. www.rcoa.ac.uk/periopmed/animation

40. Improving surgical outcomes
• High volume of surgery
• Outcomes poor for many patients
• Inequalities in surgical care
• Improve quality of care
• Adapt to individual patient needs

41. Last chance for questions....