Preventing surgical deaths: critical care and intensive care outreach services in the postoperative period

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Abstract
The last 200 years have seen enormous improvements in the management of patients undergoing surgery. This has been in part because of key discoveries such as anaesthesia, asepsis, antibiotics and X-rays, to name but a few. There have also been important organizational changes, including the development of postoperative recovery rooms and critical care, that have made important contributions to postoperative safety. Surgical mortality has fallen while the range and invasiveness of surgical procedures have expanded. Operations are undertaken on patients who would have formerly been deemed unsuitable because of serious comorbidity, age or physiological derangement. Surgery is not without its risks. Deaths directly attributable to anaesthesia are extremely rare. However, anaesthetic management and postoperative care are important in preventing surgical deaths. There will undoubtedly be further discoveries that will benefit patients having surgery. There is good evidence that a greater provision of critical care support can save lives now.