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Purpose of reviewTimely identification of surgery patients at risk of postoperative complications is important to improve the care process, including critical care. This review discusses epidemiology and impact of postoperative complications; prediction scores used to identify surgical patients at risk of complications, and the role of critical care in the postoperative management. It also discusses how critical care may change, with respect to admission to the ICU.Recent findingOptimization of postoperative outcome, next to preoperative and intraoperative optimization, consists of using risk scores to early identify patients at risk of developing complications. Critical care consultancy should be performed in the ward after surgery, if necessary. ICUs could work at different levels of intensity, but remain preferably multidisciplinary, combining care for surgical and medical patients. ICU admission should still be considered for those patients at very high risk of postoperative complications, and for those receiving complex or emergency interventions.SummaryTo optimize critical care resources for surgery patients at high risk of postoperative complications, the care process should not only include critical care and monitoring in ICUs, but also strict monitoring in the ward. Prediction scores could help to timely identify patients at risk. More intense care (monitoring) outside the ICU could improve outcome. This concept of critical care without borders could be implemented in the near future to optimize the local resources and improve patient safety. Predict more, do less in ICUs, and more in the ward.

Original publication

DOI

10.1097/mcc.0000000000000557

Type

Journal

Current opinion in critical care

Publication Date

12/2018

Volume

24

Pages

581 - 587

Addresses

Anaesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology.

Keywords

Humans, Postoperative Complications, Monitoring, Physiologic, Critical Care, Patient Admission, Postoperative Period, Intensive Care Units, Triage, Guideline Adherence, Hemodynamics, Practice Guidelines as Topic