[Perioperative Management: from the OR to the ICU]

Abstract

Patients who undergo high-risk surgical procedures represent a large proportion of admissions to intensive care units. Postoperative outcomes are a result of the complex interplay between the exact surgical procedure performed, the previous health of the patient, and specific intra- and postoperative events. Appropriate triage of patients to intensive care postoperatively may have a relevant impact on patient outcomes after high-risk surgery. It remains challenging to accurately identify patients who are at high risk of complications or death and target the patients who will benefit most from this highest level of postoperative care. "Failure to rescue" as an expression for the proportion of deaths in patients who developed a postoperative complication out of the total number of patients who developed a postoperative complication adds to the mortality of surgical patients. General wards may not properly recognize and manage postoperative complications when they occur which emphasises the necessity for adequate triage of intensive care capacity. When admission to the intensive care unit is granted patient transport from the operating room to the intensive care unit and patient handover to ICU-staff are further issues relevant to postoperative patient safety. Intrahospital transports are prone to adverse events and need careful preparation to be executed safely. In addition, exchange of clinical information during the transfer of responsibility between anesthesiologist and the intensive care physician has been recognized as a high-risk area for medical errors to occur. Structured handover protocols can reduce communication breakdowns during postoperative transfer of patients from the OR to the ICU.