Welcome to Perioperative Medicine

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