[Perioperative risk in critically ill surgical patients]

A statistical analysis of perioperative risks in 2,570 ASA III and IV patients undergoing elective surgery (general, orthopedic and urological operations) revealed a correlation of preoperative findings to intra- and postoperative morbidity and mortality. The ASA physical status classification allowed prospective evaluation of the perioperative risks in patients with severe to life-threatening diseases. Intraoperative complications were found in 15% of ASA III patients and in 39% of ASA IV patients; mortality due to anesthesia was 0. Hospital mortality was 1.7% in ASA III and 4.3% in ASA IV patients. The relatively low mortality may be due partly to the fact that no emergency surgery, cardiothoracic surgery or neurosurgery was performed, and partially to the fact that careful preoperative evaluations and therapy were carried out by anesthesiologists. Cardiac disease was the most frequent preoperative problem. Cardiac complications occurred most frequently intra- and postoperatively, and cardiac decompensation was the most frequent cause of mortality. Disturbance of kidney function was the second most important postoperative complication and cause of hospital mortality. A retrospective study of the patients with postoperative kidney problems revealed above normal preoperative creatinine values and higher postoperative increases compared with patients without complications. Intensive perioperative monitoring and therapy could possibly reduce morbidity and mortality due to renal insufficiency.