%0 Journal Article
%T Welcome to Perioperative Medicine
%A Mark Hamilton
%A Monty G Mythen
%J Perioperative Medicine
%D 2012
%I BioMed Central
%R 10.1186/2047-0525-1-1
%X The recent publication from the UK¡¯s National Confidential Enquiry into Patient Outcome and Death entitled ¡®Peri-operative Care: Knowing the Risk (2011)¡¯ paints a grim picture [9]. It concludes that overall the care of patients was substandard in the majority of high-risk patients. The thirty day mortality in those patients in whom the advisors considered there to have been inadequate pre-operative fluid management was 20.5% compared to 4.7% mortality in those with adequate pre-operative fluid therapy. Patients who suffered intra-operative complications had a thirty day mortality of 13.2% compared to 5.7% in those without. Yet, cardiac output monitoring was rarely used in high-risk patients and inadequate intra-operative monitoring was associated with a three-fold increase in mortality. Reports from the USA tell similar stories. For example, the Veterans¡¯ Association National Surgical Quality Improvement Program (NSQIP) found that the occurrence of a thirty day postoperative complication is the single most important factor determining survival after major surgery [10]. More recently Birkmeyer et al. demonstrated that the costs of inpatient surgery are thousands of dollars more per patient on average at hospitals with high complications. They concluded that their ¡°findings suggest that local, regional, and national efforts aimed at improving surgical quality may ultimately reduce costs and improve outcomes¡± [11]. They went on to note that ¡°achieving superior outcomes in surgery may require that hospitals invest in expensive resources, such as intensivist-staffed intensive care units, high nurse-to-bed ratios, advanced technology, and specialist services¡±. If improvements are to be made then we must share, spread and adopt best practice whilst examining the efficacy and effectiveness of innovative care pathways and technologies. This is a core objective of the new journal, Perioperative Medicine.In the UK we have recently seen dramatic improvements in the care of pati
%U http://www.perioperativemedicinejournal.com/content/1/1/1