Randomized evidence for reduction of perioperative mortality

Area of Science:

• Perioperative Medicine
• Evidence-Based Practice
• Surgical Outcomes Research

Background:

• Over 220 million major surgeries occur annually, highlighting the potential for significant life-saving impacts from even minor reductions in perioperative mortality.
• Identifying nonsurgical interventions that influence perioperative mortality is crucial for improving patient outcomes and healthcare efficiency.

Framework:

• An international consensus conference was convened to systematically review randomized evidence on nonsurgical interventions.
• Eligibility criteria included peer-reviewed publications, nonsurgical interventions in adult surgery, and statistically significant effects on mortality.

Implementation:

• Systematic literature searches and expert consultations were employed to identify relevant studies up to June 8, 2011.
• Over 1,000 physicians from 77 countries participated in this web-based consensus conference.

Implications:

• Fourteen interventions were identified as potentially altering perioperative mortality.
• Interventions suggested to reduce mortality include chlorhexidine oral rinse, clonidine, insulin, intra-aortic balloon pump, leukodepletion, levosimendan, neuraxial anesthesia, noninvasive respiratory support, hemodynamic optimization, oxygen, selective decontamination of the digestive tract, and volatile anesthetics.
• Conversely, aprotinin and extended-release metoprolol were identified as potentially increasing mortality, warranting further investigation and careful consideration in clinical practice.