Patients with comorbidities: what shall we do to improve the outcome

The number of patients submitted to major surgery affected by one or more comorbidities is progressively increasing. Outcome is the final output measured as morbidity, mortality and quality of life, of diagnostic tests, procedures, therapy tools started in the preoperative period and fitted on single patients or groups of patients or typology of surgical acts. Strategies to improve outcome can be divided in some fundamental steps: preoperative evaluation; optimization and no discontinuation of preoperative drug treatments, mainly in cardiac patient; choice of adequate monitoring techniques, checking of patient metabolic state and oxidative balance; choice of the best anesthesia; postoperative care, particularly due to identify the best management of the critical patient between the different levels of assistance. In conclusion, a patient with comorbidities scheduled for major surgery needs a full anesthetist-intensivist involvement, which broadens the role of the anesthetist in the perioperative medicine. Outcome is the result of many interventions during patient course, including economic costs and the importance of an appropriate treatment.