Intensive Care Medicine

, Volume 45, Issue 12, pp 1799–1801 | Cite as

Post-operative intensive care: is it really necessary?

  • R. M. J. Cashmore
  • A. J. Fowler
  • R. M. PearseEmail author
What's New in Intensive Care

It is estimated that more than 310 million patients receive a surgical treatment each year [1], and the number of procedures performed each year is growing [2, 3, 4, 5, 6]. Despite a majority of cases being performed without significant complication, deaths after surgery have recently been demonstrated to account for a large proportion of all deaths worldwide [7]. For a minority of patients, surgical procedures carry a significant burden of both death and disability. High-risk patients account for approximately 10–15% of the surgical population, but suffer around 80% of post-operative deaths [4, 8]. These high-risk patients have only been loosely defined, being typically older with a higher burden of comorbid disease. The surgical population is ageing at a faster rate than the background population [3]. With increasing numbers of procedures on increasingly high-risk patients, there is a clear need to identify possible interventions that improve peri-operative outcomes [4, 9], with...



RP is supported by an NIHR Research Professorship. AJF is supported by an NIHR Doctoral Research Fellowship (DRF-2018-11-ST2-062).

Compliance with ethical standards

Conflicts of interest

RP holds research grants, has given lectures, and/or performed consultancy work for Nestle Health Sciences, BBraun, Medtronic, Glaxo SmithKline, Intersurgical, and Edwards Lifesciences. All the other authors declare no conflicts of interest.


  1. 1.
    Weiser TG, Haynes AB, Molina G et al (2015) Estimate of the global volume of surgery in 2012: an assessment supporting improved health outcomes. Lancet 385:S11. CrossRefPubMedGoogle Scholar
  2. 2.
    Gillies MA, Sander M, Shaw A et al (2017) Current research priorities in perioperative intensive care medicine. Intensive Care Med 43:1173–1186CrossRefGoogle Scholar
  3. 3.
    Fowler AJ, Abbott TEF, Prowle J, Pearse RM (2019) Age of patients undergoing surgery. Br J Surg. CrossRefPubMedGoogle Scholar
  4. 4.
    Pearse RM, Holt PJE, Grocott MPW (2011) Managing perioperative risk in patients undergoing elective non-cardiac surgery. BMJ 343:d5759CrossRefGoogle Scholar
  5. 5.
    Ghaffar S, Pearse RM, Gillies MA (2017) ICU admission after surgery. Curr Opin Crit Care 23:424–429. CrossRefPubMedGoogle Scholar
  6. 6.
    Edwards MR, Forbes G, MacDonald N et al (2019) Optimisation of perioperative cardiovascular management to improve surgical outcome II (OPTIMISE II) trial: study protocol for a multicentre international trial of cardiac output-guided fluid therapy with low-dose inotrope infusion compared with usual care in patients undergoing major elective gastrointestinal surgery. BMJ Open 9:e023455. CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Nepogodiev D, Martin J, Biccard B et al (2019) Global burden of postoperative death. Lancet 393:401CrossRefGoogle Scholar
  8. 8.
    Pearse RM, Moreno RP, Bauer P et al (2012) Mortality after surgery in Europe: a 7 day cohort study. Lancet 380:1059–1065. CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Kahan BC, Koulenti D, Arvaniti K et al (2017) Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries. Intensive Care Med 43:971–979. CrossRefPubMedGoogle Scholar
  10. 10.
    Pearse R, Dawson D, Fawcett J et al (2005) Early goal-directed therapy after major surgery reduces complications and duration of hospital stay. A randomised, controlled trial [ISRCTN38797445]. Crit Care 9:R687–R693. CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Peden CJ, Stephens T, Martin G et al (2019) Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial. Lancet 393:2213–2221CrossRefGoogle Scholar
  12. 12.
    Ljungqvist O, Scott M, Fearon KC (2017) Enhanced recovery after surgery a review. JAMA Surg 152:292–298. CrossRefPubMedGoogle Scholar
  13. 13.
    Gillies MA, Pearse RM (2016) Intensive care after high-risk surgery. Anesthesiology 124:761–762. CrossRefPubMedGoogle Scholar
  14. 14.
    Jerath A, Laupacis A, Austin PC et al (2018) Intensive care utilization following major noncardiac surgical procedures in Ontario, Canada: a population-based study. Intensive Care Med 44:1427–1435. CrossRefPubMedGoogle Scholar
  15. 15.
    Gillies MA, Harrison EM, Pearse RM et al (2017) Intensive care utilization and outcomes after high-risk surgery in Scotland: a population-based cohort study. Br J Anaesth 118:123–131. CrossRefPubMedGoogle Scholar
  16. 16.
    Vincent J-L, Singer M (2010) Series critical care 3 critical care: advances and future perspectives. Lancet 376:1354–1361. CrossRefPubMedGoogle Scholar
  17. 17.
    Murthy S, Wunsch H (2012) Clinical review: international comparisons in critical care-lessons learned. Crit Care 16:1–7CrossRefGoogle Scholar
  18. 18.
    Ozdemir BA, Sinha S, Karthikesalingam A et al (2016) Mortality of emergency general surgical patients and associations with hospital structures and processes. Br J Anaesth 116:54–62. CrossRefPubMedGoogle Scholar
  19. 19.
    Gillies MA, Power GS, Harrison DA et al (2015) Regional variation in critical care provision and outcome after high-risk surgery. Intensive Care Med 41:1809–1816. CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Critical Care and Perioperative Medicine Research GroupQueen Mary University of LondonLondonUK
  2. 2.Adult Critical Care UnitRoyal London HospitalLondonUK

Personalised recommendations