Transforming Postoperative Care: Advanced Recovery Room Care for Intermediate-risk Noncardiac Surgical Patients

The risk of death in the first 30 days after noncardiac surgery is 140 times higher than during the procedure itself. While advances in surgery and anesthesia care have reduced intraoperative mortality 10-fold, improvements in postoperative care have lagged behind. Although high-risk patients may be electively admitted to an intensive care unit, most intermediate-risk patients (2 to 4% mortality) are usually transferred from the postanesthesia care unit to general surgical wards, where vital signs are typically assessed every 4 to 6 h, which may delay early recognition of clinical deterioration. In contrast, nearly all cardiac surgical patients, including those at low risk, receive intensive care unit-level care. Intermediate-risk noncardiac surgical patients may benefit from advanced recovery room care, which may extend mortality reductions made in the intraoperative period to the postoperative period by providing continuous hemodynamic monitoring and advanced therapies such as vasoactive infusions until the morning of postoperative day 1.