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Perioperatives Risiko und Letalität nach großen chirurgischen Eingriffen

Perioperative risk and mortality after major surgery

  • Leitthema
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Zusammenfassung

Obwohl die anästhesieassoziierte Sterblichkeit mit 0,00068–0,00082 % seit Jahrzehnten auf niedrigem Niveau ist, zeigen aktuelle Studien eine weiterhin hohe durchschnittliche postoperative Letalität von 0,8–4 %. Neben chirurgisch bedingten schweren Komplikationen beeinflusst v. a. die patienteneigene Komorbidität das Behandlungsergebnis negativ. Risikofaktoren prädisponieren einerseits für akut auftretende Zwischenfälle (z. B. Myokardinfarkt), andererseits entsteht ein Großteil der letalen Komplikationen mit einer langsamen Progredienz, v. a. Infektionen oder Folgen der systemischen Inflammation. Deshalb besteht ein Zeitfenster zur Erkennung und zur Therapie zahlreicher perioperativer Komplikationen, das oft nicht zur Verbesserung des Behandlungsergebnisses genutzt wird.

In diesem Zusammenhang wurde der Begriff „failure to rescue“ (FTR) als Indikator der perioperativen Patientenversorgung eingeführt, gemeint ist derjenige Anteil von Patienten, die eine schwere postoperative Komplikation erleiden und letztendlich an dieser Komplikation versterben. Failure to rescue scheint in der perioperativen Medizin eine bislang unterschätzte Rolle zu spielen, aber einen signifikanten Anteil der postoperativen Letalität zu verursachen bzw. zumindest an deren Entstehung beteiligt zu sein. Während die Häufigkeit von postoperativen Komplikationen zwischen verschiedenen Krankenhäusern erstaunlich wenig variiert, unterscheidet sich die Letalität nach Komplikationen z. T. erheblich, was auf ein erhebliches Verbesserungspotenzial hinweist. Bei ca. 14 Mio. Operationen in Deutschland mit einer postoperativen Sterblichkeit von ca. 1 % und einem vermeidbaren FTR-Anteil von 40 % wären dies geschätzte 60.000 vermeidbare Todesfälle. Eine wesentliche Aufgabe der Zukunft wird es daher sein, FTR zu vermeiden. Hierfür müssen 1) die Risikopatienten identifiziert, 2) die Entstehung von postoperativen Komplikationen durch geeignete perioperative adjunktive Therapiestrategien möglichst vermieden, 3) ein Überwachungssystem zur Früherkennung von Komplikationen etabliert sowie 4) auftretende Komplikationen suffizient und frühzeitig behandelt werden.

Abstract

Although anesthesia-associated mortality has been significantly reduced down to 0.00068–0.00082 % over the last decades, recent studies have revealed a high perioperative mortality of 0.8− 4 %. Apart from anesthesia and surgery-induced major complications, perioperative mortality is primarily negatively influenced by individual patient comorbidities. These risk factors predispose for acute critical incidents (e.g. myocardial infarction); however, the majority of fatal complications are a result of slowly progressing conditions, particularly infections or the sequelae of systemic inflammation. This implicates a broad window of opportunity for the detection and treatment of slow-onset complications to improve the perioperative outcome. The term “failure to rescue” (FTR), i.e. the proportion of patients who die from major complications compared to the number of all patients with complications, has been introduced as a valid indicator for the quality of perioperative care. Growing evidence has already shown that FTR is an underestimated factor in perioperative medicine accounting for or at least being involved in the development of postoperative mortality. While the incidence of severe postoperative complications amazingly does not show much variation between hospitals, FTR shows significant differences implying a major potential for improvement. With 14 million surgical procedures per year in Germany, a postoperative mortality of approximately 1 % and an avoidable FTR rate of 40 % mean that there are an estimated 60,000 preventable deaths per year. Hence, in the future it will be imperative to (1) identify patients at risk, (2) to prevent the development of postoperative complications with the use of adequate adjunctive therapeutic strategies, (3) to establish surveillance and monitoring systems for the early detection of postoperative complications and (4) to treat postoperative complications efficiently and in time when they arise.

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Literatur

  1. Abdelmalak BB, Knittel J, Abdelmalak JB et al (2014) Preoperative blood glucose concentrations and postoperative outcomes after elective non-cardiac surgery: an observational study. Br J Anaesth 112:79–88

    Article  CAS  PubMed  Google Scholar 

  2. Adogwa O, Martin JR, Huang K et al (2014) Preoperative serum albumin level as a predictor of postoperative complication after spine fusion. Spine 39:1513–1519

    Article  PubMed  Google Scholar 

  3. Archan S, Roscher CR, Fairman RM et al (2010) Revised Cardiac Risk Index (Lee) and perioperative cardiac events as predictors of long-term mortality in patients undergoing endovascular abdominal aortic aneurysm repair. J Cardiothorac Vasc Anesth 24:84–90

    Article  PubMed  Google Scholar 

  4. Athyros VG, Katsiki N, Doumas M et al (2013) Effect of tobacco smoking and smoking cessation on plasma lipoproteins and associated major cardiovascular risk factors: a narrative review. Curre Med Res Opin 29:1263–1274

    Article  Google Scholar 

  5. Baehner T, Boehm O, Probst C et al (2012) [Cardiopulmonary bypass in cardiac surgery]. Anaesthesist 61:846–856

    Article  CAS  PubMed  Google Scholar 

  6. Balas MC, Vasilevskis EE, Olsen KM et al (2014) Effectiveness and Safety of the Awakening and Breathing Coordination, Delirium Monitoring/Management, and Early Exercise/Mobility Bundle. Crit Care Med 42:1024–1036

    Article  PubMed Central  PubMed  Google Scholar 

  7. Bandholm T, Kehlet H (2012) Physiotherapy exercise after fast-track total hip and knee arthroplasty: time for reconsideration? Arch Phys Med Rehabil 93:1292–1294

    Article  PubMed  Google Scholar 

  8. Berrington De Gonzalez A, Hartge P, Cerhan JR et al (2010) Body-mass index and mortality among 1.46 million white adults. N Engl J Med 363:2211–2219

    Article  CAS  PubMed  Google Scholar 

  9. Biccard B (2015) Proposed research plan for the derivation of a new cardiac risk index. Anesth Analg 120:543–553

    Article  PubMed  Google Scholar 

  10. Biccard BM, Devereaux PJ, Rodseth RN (2014) Cardiac biomarkers in the prediction of risk in the non-cardiac surgery setting. Anaesthesia 69:484–493

    Article  CAS  PubMed  Google Scholar 

  11. Bohmer AB, Defosse J, Geldner G et al (2012) [Preoperative risk evaluation of adult patients for elective, noncardiac surgical interventions. Results of an on-line survey on the status in Germany]. Anaesthesist 61:407–419

    Article  CAS  PubMed  Google Scholar 

  12. Boreland L, Scott-Hudson M, Hetherington K et al (2015) The effectiveness of tight glycemic control on decreasing surgical site infections and readmission rates in adult patients with diabetes undergoing cardiac surgery: a systematic review. Heart Lung 44:430–440

    Article  PubMed  Google Scholar 

  13. Bothner U, Schwilk B, Steffen P et al (1996) [Perioperative monitoring of the course of anesthesia, the postanesthesia visit and inquiry of patient satisfaction. A prospective study of parameters in process and outcome quality in anesthesia]. Anasthesiol Intensivmed Notfallmed Schmerzther 31:608–614

    Article  CAS  PubMed  Google Scholar 

  14. Botto F, Alonso-Coello P, Chan MT et al (2014) Myocardial injury after noncardiac surgery: a large, international, prospective cohort study establishing diagnostic criteria, characteristics, predictors, and 30-day outcomes. Anesthesiology 120:564–578

    Article  PubMed  Google Scholar 

  15. Broch O, Bein B, Gruenewald M et al (2013) A comparison of continuous non-invasive arterial pressure with invasive radial and femoral pressure in patients undergoing cardiac surgery. Minerva Anestesiol 79:248–256

    CAS  PubMed  Google Scholar 

  16. Buist M, Harrison J, Abaloz E et al (2007) Six year audit of cardiac arrests and medical emergency team calls in an Australian outer metropolitan teaching hospital. BMJ 335:1210–1212

    Article  PubMed Central  PubMed  Google Scholar 

  17. Burkle CM, Pasternak JJ, Armstrong MH et al (2013) Patient perspectives on informed consent for anaesthesia and surgery: american attitudes. Acta Anaesthesiol Scand 57:342–349

    Article  CAS  PubMed  Google Scholar 

  18. Canet J, Sabate S, Mazo V et al (2015) Development and validation of a score to predict postoperative respiratory failure in a multicentre European cohort: a prospective, observational study. Eur J Anaesthesiol 32:458–470

    Article  PubMed  Google Scholar 

  19. Cannesson M, Rinehart J (2014) Closed-loop systems and automation in the era of patients safety and perioperative medicine. J Clin Monit Comput 28:1–3

    Article  PubMed  Google Scholar 

  20. Cannesson M, Pestel G, Ricks C et al (2011) Hemodynamic monitoring and management in patients undergoing high risk surgery: a survey among North American and European anesthesiologists. Crit Care 15:R197

    Article  PubMed Central  PubMed  Google Scholar 

  21. Caplan RA, Posner KL, Ward RJ et al (1990) Adverse respiratory events in anesthesia: a closed claims analysis. Anesthesiology 72:828–833

    Article  CAS  PubMed  Google Scholar 

  22. Caplan RA, Vistica MF, Posner KL et al (1997) Adverse anesthetic outcomes arising from gas delivery equipment: a closed claims analysis. Anesthesiology 87:741–748

    Article  CAS  PubMed  Google Scholar 

  23. Choi JY, Yoon SJ, Kim SW et al (2015) Prediction of Postoperative Complications Using Multidimensional Frailty Score in Older Female Cancer Patients with American Society of Anesthesiologists Physical Status Class 1 or 2. J Am Coll Surg 221:652-660

    Article  PubMed  Google Scholar 

  24. Clarke SP, Aiken LH (2003) Failure to rescue. Am J Nurs 103:42–47

    Article  PubMed  Google Scholar 

  25. Cohen MM, Duncan PG, Tate RB (1988) Does anesthesia contribute to operative mortality? JAMA 260:2859–2863

    Article  CAS  PubMed  Google Scholar 

  26. Crivelli JJ, Xylinas E, Kluth LA et al (2013) Effect of Smoking on Outcomes of Urothelial Carcinoma: a systematic review of the literature. Eur Urol 65:742–754

    Article  PubMed  CAS  Google Scholar 

  27. D’apuzzo MR, Pao AW, Novicoff WM et al (2014) Age as an independent risk factor for postoperative morbidity and mortality after total joint arthroplasty in patients 90 years of age or older. J Arthroplasty 29:477–480

    Article  PubMed  Google Scholar 

  28. De Waal BA, Buise MP, Van Zundert AA (2015) Perioperative statin therapy in patients at high risk for cardiovascular morbidity undergoing surgery: a review. Br J Anaesth 114:44–52

    Article  PubMed  Google Scholar 

  29. Devereaux PJ, Goldman L, Cook DJ et al (2005) Perioperative cardiac events in patients undergoing noncardiac surgery: a review of the magnitude of the problem, the pathophysiology of the events and methods to estimate and communicate risk. CMAJ 173:627–634

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  30. Dolmatova E, Mahida S, Ellinor PT et al (2013) Genetic etiology and evaluation of sudden cardiac death. Curr Cardiol Rep 15:389

    Article  PubMed  Google Scholar 

  31. Duceppe E, Mrkobrada M, Thomas S et al (2015) Role of aspirin for prevention and treatment of perioperative cardiovascular events. J Thromb Haemost 13(Suppl 1):S297–S303

    Article  CAS  PubMed  Google Scholar 

  32. Dussaussoy C, Peres M, Jaoul V et al (2014) Automated titration of propofol and remifentanil decreases the anesthesiologist’s workload during vascular or thoracic surgery: a randomized prospective study. J Clin Monit Comput 28:35–40

    Article  PubMed  Google Scholar 

  33. Farrugia A (2011) Falsification or paradigm shift? Toward a revision of the common sense of transfusion. Transfusion 51:216–224

    Article  PubMed  Google Scholar 

  34. Fischer D, Byhahn C, Reyher C et al (2013) [The Helsinki declaration for patient safety in Anaesthesiology – preoperative assessment and preparation]. Anasthesiol Intensivmed Notfallmed Schmerzther 48:392–396

    Article  PubMed  Google Scholar 

  35. Fleisher LA, Beckman JA, Brown KA et al (2007) ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery): developed in collaboration with the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, and Society for Vascular Surgery. Circulation 116:e418–e499

    Article  PubMed  Google Scholar 

  36. Fowkes FG, Lunn JN, Farrow SC et al (1982) Epidemiology in anaesthesia. III: mortality risk in patients with coexisting physical disease. Br J Anaesth 54:819–825

    Article  CAS  PubMed  Google Scholar 

  37. Fuchs-Buder T, Eikermann M (2006) [Residual neuromuscular blockades. Clinical consequences, frequency and avoidance strategies]. Anaesthesist 55:7–16

    Article  CAS  PubMed  Google Scholar 

  38. Garcea G, Thomasset S, Mcclelland L et al (2004) Impact of a critical care outreach team on critical care readmissions and mortality. Acta Anaesthesiol Scand 48:1096–1100

    Article  CAS  PubMed  Google Scholar 

  39. Garg T, Chen LY, Kim PH et al (2014) Preoperative serum albumin is associated with mortality and complications after radical cystectomy. BJU Int 113:918–923

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  40. Gawande AA, Thomas EJ, Zinner MJ et al (1999) The incidence and nature of surgical adverse events in Colorado and Utah in 1992. Surgery 126:66–75

    Article  CAS  PubMed  Google Scholar 

  41. Ghaferi AA (2011) Hospital volume and failure to rescue with high-risk surgery. Med Care 49:1076–1081

    Article  PubMed  Google Scholar 

  42. Ghaferi AA, Birkmeyer JD, Dimick JB (2009) Variation in hospital mortality associated with inpatient surgery. N Engl J Med 361:1368–1375

    Article  CAS  PubMed  Google Scholar 

  43. Glance LG (2012) The Surgical Mortality Probability Model: derivation and validation of a simple risk prediction rule for noncardiac surgery. Ann Surg 255:696–702

    Article  PubMed  Google Scholar 

  44. Glance LG, Wissler R, Mukamel DB et al (2010) Perioperative outcomes among patients with the modified metabolic syndrome who are undergoing noncardiac surgery. Anesthesiology 113:859–872

    Article  PubMed  Google Scholar 

  45. Glozier N, Tofler GH, Colquhoun DM et al (2013) Psychosocial risk factors for coronary heart disease. Med J Aust 199:179–180

    Article  PubMed  Google Scholar 

  46. Goodnough LT, Levy JH, Murphy MF (2013) Concepts of blood transfusion in adults. Lancet 381:1845–1854

    Article  PubMed  Google Scholar 

  47. Gottschalk A, Van Aken H, Zenz M et al (2011) Is anesthesia dangerous? Dtsch Arztebl Int 108:469–474

    PubMed Central  PubMed  Google Scholar 

  48. Gray A (2000) United Kingdom national confidential enquiry into perioperative deaths. Minerva Anestesiol 66:288–292

    CAS  PubMed  Google Scholar 

  49. Grobben RB, Van Klei WA, Grobbee DE et al (2013) The aetiology of myocardial injury after non-cardiac surgery. Neth Heart J

  50. Guarracino F, Baldassarri R (2009) Transesophageal echocardiography in the OR and ICU. Minerva Anestesiol 75:518–529

    CAS  PubMed  Google Scholar 

  51. Guralnik JM, Ershler WB, Schrier SL et al (2005) Anemia in the elderly: a public health crisis in hematology. Hematology Am Soc Hematol Educ Program 2005:528–532

    Article  Google Scholar 

  52. Haynes AB, Regenbogen SE, Weiser TG et al (2011) Surgical outcome measurement for a global patient population: validation of the Surgical Apgar Score in 8 countries. Surgery 149:519–524

    Article  PubMed  Google Scholar 

  53. Hemmerling TM, Romano G, Terrasini N et al (2013) Anesthesia for off-pump coronary artery bypass surgery. Ann Card Anaesth 16:28–39

    Article  PubMed  Google Scholar 

  54. Henneman D, Van Leersum NJ, Ten Berge M et al (2013) Failure-to-rescue after colorectal cancer surgery and the association with three structural hospital factors. Ann Surg Oncol 20:3370–3376

    Article  CAS  PubMed  Google Scholar 

  55. Hillman K, Chen J, Cretikos M et al (2005) Introduction of the medical emergency team (MET) system: a cluster-randomised controlled trial. Lancet 365:2091–2097

    Article  PubMed  Google Scholar 

  56. Honda M, Kuriyama A, Noma H et al (2013) Hand-sewn versus mechanical esophagogastric anastomosis after esophagectomy: a systematic review and meta-analysis. Ann Surg 257:238–248

    Article  PubMed  Google Scholar 

  57. Hoogeboom TJ, Van Meeteren NL, Schank K et al (2015) Risk factors for delayed inpatient functional recovery after total knee arthroplasty. BioMed Res Int 2015:167643

    Article  PubMed Central  PubMed  Google Scholar 

  58. Hua M, Brady JE, Li G (2012) A scoring system to predict unplanned intubation in patients having undergone major surgical procedures. Anesth Analg 115:88–94

    Article  PubMed Central  PubMed  Google Scholar 

  59. Jones D, Bellomo R, Bates S et al (2005) Long term effect of a medical emergency team on cardiac arrests in a teaching hospital. Crit Care 9:R808–R815

    Article  PubMed Central  PubMed  Google Scholar 

  60. Jones D, Opdam H, Egi M et al (2007) Long-term effect of a Medical Emergency Team on mortality in a teaching hospital. Resuscitation 74:235–241

    Article  PubMed  Google Scholar 

  61. Jorgensen CC, Jacobsen MK, Soeballe K et al (2013) Thromboprophylaxis only during hospitalisation in fast-track hip and knee arthroplasty, a prospective cohort study. BMJ Open 3:e003965

    Article  PubMed Central  PubMed  Google Scholar 

  62. Kable AK, Gibberd RW, Spigelman AD (2002) Adverse events in surgical patients in Australia. Int J Qual Health Care 14:269–276

    Article  CAS  PubMed  Google Scholar 

  63. Kalisch BJ, Lee S, Dabney BW (2013) Outcomes of inpatient mobilization: a literature review. J Clin Nurs 23:1486–1501

    Article  PubMed  Google Scholar 

  64. Khaladj N, Bobylev D, Peterss S et al (2013) Immediate surgical coronary revascularisation in patients presenting with acute myocardial infarction. J Cardiothorac Surg 8:167

    Article  PubMed Central  PubMed  Google Scholar 

  65. Khuri SF, Henderson WG, Depalma RG et al (2005) Determinants of long-term survival after major surgery and the adverse effect of postoperative complications. Ann Surg 242:326–341. (discussion 341–323)

    PubMed Central  PubMed  Google Scholar 

  66. Kristensen SD, Knuuti J, Saraste A et al (2014) 2014 ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management: the Joint Task Force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA). Eur Heart J 35:2383–2431

    Article  PubMed  Google Scholar 

  67. Kumar A, Roberts D, Wood KE et al (2006) Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med 34:1589–1596

    Article  PubMed  Google Scholar 

  68. Lee TH, Marcantonio ER, Mangione CM et al (1999) Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation 100:1043–1049

    Article  CAS  PubMed  Google Scholar 

  69. Li G, Warner M, Lang BH et al (2009) Epidemiology of anesthesia-related mortality in the United States, 1999–2005. Anesthesiology 110:759–765

    Article  PubMed Central  PubMed  Google Scholar 

  70. Lienhart A, Auroy Y, Pequignot F et al (2006) Survey of anesthesia-related mortality in France. Anesthesiology 105:1087–1097

    Article  PubMed  Google Scholar 

  71. Ma J, Xin Q, Wang X et al (2015) Prediction of perioperative cardiac events through preoperative NT-pro-BNP and cTnI after emergent non-cardiac surgery in elderly patients. PLoS One 10:e0121306

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  72. Mahdi H, Lockhart D, Maurer KA (2015) Impact of age on 30-day mortality and morbidity in patients undergoing surgery for endometrial cancer. Gynecol Oncol 137:106–111

    Article  PubMed  Google Scholar 

  73. Mangano DT (1990) Perioperative cardiac morbidity. Anesthesiology 72:153–184

    Article  CAS  PubMed  Google Scholar 

  74. Mangano DT, Browner WS, Hollenberg M et al (1992) Long-term cardiac prognosis following noncardiac surgery. The Study of Perioperative Ischemia Research Group. JAMA 268:233–239

    Article  CAS  PubMed  Google Scholar 

  75. Manolis AJ, Poulimenos LE, Kallistratos MS et al (2013) Sympathetic overactivity in hypertension and cardiovascular disease. Curr Vasc Pharmacol 12:4–15

    Google Scholar 

  76. Mazo V, Sabate S, Canet J et al (2014) Prospective external validation of a predictive score for postoperative pulmonary complications. Anesthesiology 121:219–231

    Article  PubMed  Google Scholar 

  77. Mccullough PA, Barnard D, Clare R et al (2013) Anemia and associated clinical outcomes in patients with heart failure due to reduced left ventricular systolic function. Clinical Cardiol 36:611–620

    Google Scholar 

  78. Mencke T, Echternach M, Kleinschmidt S et al (2003) Laryngeal morbidity and quality of tracheal intubation: a randomized controlled trial. Anesthesiology 98:1049–1056

    Article  CAS  PubMed  Google Scholar 

  79. Mitchell M (2013) Anaesthesia type, gender and anxiety. J Perioper Pract 23:41–47

    PubMed  Google Scholar 

  80. Monk TG, Saini V, Weldon BC et al (2005) Anesthetic management and one-year mortality after noncardiac surgery. Anesth Analg 100:4–10

    Article  PubMed  Google Scholar 

  81. Moran PJ, Ghidella T, Power G et al (2008) The use of Lee and co-workers’ index to assist a risk adjusted audit of perioperative cardiac outcome. Anaesth Intensive Care 36:167–173

    CAS  PubMed  Google Scholar 

  82. Mullen JT, Moorman DW, Davenport DL (2009) The obesity paradox: body mass index and outcomes in patients undergoing nonbariatric general surgery. Ann Surg 250:166–172

    Article  PubMed  Google Scholar 

  83. Neves AL, Coelho J, Couto L et al (2013) Metabolic endotoxemia: a molecular link between obesity and cardiovascular risk. J Mol Endocrinol 51:R51–R64

    Article  CAS  PubMed  Google Scholar 

  84. Noordzij PG, Van Geffen O, Dijkstra IM et al (2015) High-sensitive cardiac troponin T measurements in prediction of non-cardiac complications after major abdominal surgery. Br J Anaesth 114:909–918

    Article  CAS  PubMed  Google Scholar 

  85. Norcini JJ, Boulet JR, Opalek A et al (2013) Outcomes of cardiac surgery: associations with physician characteristics, institutional characteristics, and transfers of care. Med Care 51:1034–1039

    Article  PubMed  Google Scholar 

  86. Pandey CK, Karna ST, Pandey VK et al (2012) Perioperative risk factors in patients with liver disease undergoing non-hepatic surgery. World J Gastrointest Surg 4:267–274

    Article  PubMed Central  PubMed  Google Scholar 

  87. Pearse RM, Moreno RP, Bauer P et al (2012) Mortality after surgery in Europe: a 7 day cohort study. Lancet 380:1059–1065

    Article  PubMed Central  PubMed  Google Scholar 

  88. Prause G, Ratzenhofer-Comenda B, Pierer G et al (1997) Can ASA grade or Goldman’s cardiac risk index predict peri-operative mortality? A study of 16,227 patients. Anaesthesia 52:203–206

    Article  CAS  PubMed  Google Scholar 

  89. Reize P, Wulker N (2007) [Foreign blood saving measures in orthopedic surgery]. Orthopade 36:537–543

    Article  CAS  PubMed  Google Scholar 

  90. Roth GA, Forouzanfar MH, Moran AE et al (2015) Demographic and epidemiologic drivers of global cardiovascular mortality. N Engl J Med 372:1333–1341

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  91. Saely CH, Rein P, Vonbank A et al (2013) Type 2 diabetes and the progression of visualized atherosclerosis to clinical cardiovascular events. Int J Cardiol 167:776–780

    Article  PubMed  Google Scholar 

  92. Salamonsen MR, Bailey MJ, Salamonsen RF (2008) Can ICU stay be predicted accurately enough for fast-tracking cardiac surgical patients? Crit Care Resusc 10:194–201

    PubMed  Google Scholar 

  93. Salhiyyah K, Elsobky S, Raja S et al (2011) A clinical and economic evaluation of fast-track recovery after cardiac surgery. Heart Surg Forum 14:E330–E334

    Article  PubMed  Google Scholar 

  94. Samet A, Capron F, Alla F et al (2005) Single acceleromyographic train-of-four, 100-Hertz tetanus or double-burst stimulation: which test performs better to detect residual paralysis? Anesthesiology 102:51–56

    Article  PubMed  Google Scholar 

  95. Schiff JH, Welker A, Fohr B et al (2014) Major incidents and complications in otherwise healthy patients undergoing elective procedures: results based on 1.37 million anaesthetic procedures. Br J Anaesth 113:109–121

    Article  CAS  PubMed  Google Scholar 

  96. Simmers D, Potgieter D, Ryan L et al (2015) The use of preoperative B-type natriuretic peptide as a predictor of atrial fibrillation after thoracic surgery: systematic review and meta-analysis. J Cardiothorac Vasc Anesth 29:389–395

    Article  CAS  PubMed  Google Scholar 

  97. Simon M (2012) Beschäftigte und Beschäftigungsstrukturen in Pflegeberufen-eine Analyse der Jahre 1999 bis 2009. Deutscher Pflegerat, Berlin, S 70

  98. Sinha N, Mukhopadhyay S, Das DN et al (2013) Relevance of cancer initiating/stem cells in carcinogenesis and therapy resistance in oral cancer. Oral Oncol 49:854–62

    Article  CAS  PubMed  Google Scholar 

  99. Siregar S, Groenwold RH, De Mol BA et al (2013) Evaluation of cardiac surgery mortality rates: 30-day mortality or longer follow-up? Eur J Cardiothorac Surg 44:875–883

    Article  PubMed  Google Scholar 

  100. Smith RC, Leung JM, Mangano DT (1991) Postoperative myocardial ischemia in patients undergoing coronary artery bypass graft surgery. S.P.I. Research Group. Anesthesiology 74:464–473

    Article  CAS  PubMed  Google Scholar 

  101. Sobol JB, Gershengorn HB, Wunsch H et al (2013) The surgical apgar score is strongly associated with intensive care unit admission after high-risk intraabdominal surgery. Anesth Analg 117:438–446

    Article  PubMed Central  PubMed  Google Scholar 

  102. Soriano JB, Rodriguez-Roisin R (2011) Chronic obstructive pulmonary disease overview: epidemiology, risk factors, and clinical presentation. Proc Am Thorac Soc 8:363–367

    Article  PubMed  Google Scholar 

  103. Spahn DR, Goodnough LT (2013) Alternatives to blood transfusion. Lancet 381:1855–1865

    Article  PubMed  Google Scholar 

  104. Spahn DR, Moch H, Hofmann A et al (2008) Patient blood management: the pragmatic solution for the problems with blood transfusions. Anesthesiology 109:951–953

    Article  PubMed  Google Scholar 

  105. Sprung J, Warner ME, Contreras MG et al (2003) Predictors of survival following cardiac arrest in patients undergoing noncardiac surgery: a study of 518,294 patients at a tertiary referral center. Anesthesiology 99:259–269

    Article  PubMed  Google Scholar 

  106. Srivastava AR, Banerjee A, Tempe DK et al (2008) A comprehensive approach to fast tracking in cardiac surgery: ambulatory low-risk open-heart surgery. Eur J Cardiothorac Surg 33:955–960

    Article  PubMed  Google Scholar 

  107. Story DA, Fink M, Leslie K et al (2009) Perioperative mortality risk score using pre- and postoperative risk factors in older patients. Anaesth Intensive Care 37:392–398

    CAS  PubMed  Google Scholar 

  108. Suri RM, Vanoverschelde JL, Grigioni F et al (2013) Association between early surgical intervention vs watchful waiting and outcomes for mitral regurgitation due to flail mitral valve leaflets. JAMA 310:609–616

    Article  CAS  PubMed  Google Scholar 

  109. Taenzer AH, Pyke JB, Mcgrath SP et al (2010) Impact of pulse oximetry surveillance on rescue events and intensive care unit transfers: a before-and-after concurrence study. Anesthesiology 112:282–287

    Article  PubMed  Google Scholar 

  110. Tahiri M, Sikder T, Maimon G et al (2015) The impact of postoperative complications on the recovery of elderly surgical patients. Surg Endosc

  111. Talsma A, Jones K, Guo Y et al (2013) The relationship between nurse staffing and failure to rescue: where does it matter most? J Patient Saf 10:133–139

    Article  Google Scholar 

  112. Toufektzian L, Zisis C, Balaka C et al (2015) Effectiveness of brain natriuretic peptide in predicting postoperative atrial fibrillation in patients undergoing non-cardiac thoracic surgery. Interact Cardiovasc Thorac Surg 20:654–657

    Article  PubMed  Google Scholar 

  113. Trinh VQ, Trinh QD, Tian Z et al (2013) In-hospital mortality and failure-to-rescue rates after radical cystectomy. BJU Int 112:E20–E27

    Article  PubMed  Google Scholar 

  114. Turan A, Mascha EJ, Roberman D et al (2011) Smoking and perioperative outcomes. Anesthesiology 114:837–846

    Article  PubMed  Google Scholar 

  115. Uppal S, Al-Niaimi A, Rice LW et al (2013) Preoperative hypoalbuminemia is an independent predictor of poor perioperative outcomes in women undergoing open surgery for gynecologic malignancies. Gynecol Oncol 131:416–422

    Article  CAS  PubMed  Google Scholar 

  116. Van Den Heede K, Lesaffre E, Diya L et al (2009) The relationship between inpatient cardiac surgery mortality and nurse numbers and educational level: analysis of administrative data. Int J Nurs Stud 46:796–803

    Article  PubMed Central  PubMed  Google Scholar 

  117. Van Der Sluis G, Goldbohm RA, Bimmel R et al (2015) What augmented physical activity and empowerment can bring to patients receiving total knee replacement: content, implementation, and comparative effectiveness of a new function-tailored care pathway in a routine care setting. Biomed Res Int 2015:745864

    PubMed Central  PubMed  Google Scholar 

  118. Vascular Events in Noncardiac Surgery Patients Cohort Evaluation Study I, Devereaux PJ, Chan MT et al (2012) Association between postoperative troponin levels and 30-day mortality among patients undergoing noncardiac surgery. JAMA 307:2295–2304

  119. Vegas A, Meineri M (2010) Core review: three-dimensional transesophageal echocardiography is a major advance for intraoperative clinical management of patients undergoing cardiac surgery: a core review. Anesth Analg 110:1548–1573

    Article  PubMed  Google Scholar 

  120. Vernick W, Fleisher LA (2008) Risk stratification. Best Pract Res Clin Anaesthesiol 22:1–21

    Article  PubMed  Google Scholar 

  121. Voepel-Lewis T, Pechlavanidis E, Burke C et al (2013) Nursing surveillance moderates the relationship between staffing levels and pediatric postoperative serious adverse events: a nested case-control study. Int J Nurs Stud 50:905–913

    Article  PubMed  Google Scholar 

  122. Wang Y, Eldridge N, Metersky ML et al (2014) National trends in patient safety for four common conditions, 2005–2011. N Engl J Med 370:341–351

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  123. Warren GW, Singh AK (2013) Nicotine and lung cancer. J Carcinog 12:1

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  124. Wehbe M, Arbeid E, Cyr S et al (2014) A technical description of a novel pharmacological anesthesia robot. J Clin Monit Comput 28:27–34

    Article  PubMed  Google Scholar 

  125. Weiser TG, Regenbogen SE, Thompson KD et al (2008) An estimation of the global volume of surgery: a modelling strategy based on available data. Lancet 372:139–144

    Article  PubMed  Google Scholar 

  126. Wilcox SR, Bittner EA, Elmer J et al (2012) Neuromuscular blocking agent administration for emergent tracheal intubation is associated with decreased prevalence of procedure-related complications. Crit Care Med 40:1808–1813

    Article  CAS  PubMed  Google Scholar 

  127. Wolters U, Wolf T, Stutzer H et al (1996) ASA classification and perioperative variables as predictors of postoperative outcome. Br J Anaesth 77:217–222

    Article  CAS  PubMed  Google Scholar 

  128. Wysocki M, Jouvet P, Jaber S (2014) Closed loop mechanical ventilation. J Clin Monit Comput 28:49–56

    Article  PubMed  Google Scholar 

  129. Xu L, Yu C, Jiang J et al (2015) Major adverse cardiac events in elderly patients with coronary artery disease undergoing noncardiac surgery: a multicenter prospective study in China. Arch Gerontol Geriatr 61:503–509

    Article  PubMed  Google Scholar 

  130. Yang Z, Liu H, Xie X et al (2014) The influence of diabetes mellitus on the post-operative outcome of elective primary total knee replacement: a systematic review and meta-analysis. Bone Joint J 96-B:1637–1643

    Article  CAS  PubMed  Google Scholar 

  131. Zanghi A, Cavallaro A, Piccolo G et al (2013) Dissemination metastasis after laparoscopic colorectal surgery versus conventional open surgery for colorectal cancer: a metanalysis. Eur Rev Med Pharmacol Sci 17:1174–1184

    CAS  PubMed  Google Scholar 

  132. Zaouter C, Wehbe M, Cyr S et al (2014) Use of a decision support system improves the management of hemodynamic and respiratory events in orthopedic patients under propofol sedation and spinal analgesia: a randomized trial. J Clin Monit Comput 28:41–47

    Article  PubMed  Google Scholar 

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  1. Klinik und Poliklinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Deutschland

    O. Boehm,  M.K.A. Pfeiffer,  G. Baumgarten &  A. Hoeft

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  1. O. Boehm
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  2. M.K.A. Pfeiffer
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  3. G. Baumgarten
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  4. A. Hoeft
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O. Boehm, M.K.A. Pfeiffer, G. Baumgarten und A. Hoeft geben an, dass keine Interessenskonflikte vorliegen.

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Boehm, O., Pfeiffer, M., Baumgarten, G. et al. Perioperatives Risiko und Letalität nach großen chirurgischen Eingriffen. Anaesthesist 64, 814–827 (2015). https://doi.org/10.1007/s00101-015-0110-y

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