Optimising oxygen delivery to the tissues in patients about to undergo major elective surgery would be a significant and cost-effective improvement in perioperative care, a study in the British Medical Journal (24 April, page 1099) has revealed.
The study at York District Hospital recruited 138 patients undergoing major elective surgery who were at risk of developing post-operative complications.
A third of patients had known ischaemic heart disease and half were aged over 70.
Patients received either routine care - monitoring oxygen delivery and responding to any changes during the operation - or optimisation of oxygen delivery four hours before the operation by giving fluid and drugs, adrenaline or dopexamine, which increase oxygen delivery. The optimisation strategy was continued after surgery for 12 to 24 hours in intensive or high-dependency care.
More than 20,000 patients die within 30 days of a surgical procedure every year in the UK. Falls in tissue oxygenation increase the likelihood of complications.
The study found that the preemptive strategy reduced mortality from 10 per cent to 3 per cent and reduced bed use by up to 40 per cent.
Those treated with dopexamine developed fewer complications than those treated with adrenaline (30 per cent versus 52 per cent).
Study leader and consultant anaesthetist Dr Jonathan Wilson suggested that giving additional fluid preoperatively was the major contributor to improved oxygen delivery.
He also said: 'Values for the usage of intensive care beds or high dependency care beds and length of stay in hospital suggest there may be overall savings in hospital costs when pre-optimising patients for major elective surgery.'
Commenting on the study in the British Medical Journal , Professor David Bennett, professor of intensive care at St George's Hospital medical school in London, said: 'If it is agreed the evidence is there to support the practice of optimisation, its cost will have to be calculated into the price of operating on these patients.
'The benefits in survival, reduced morbidity and shorter hospital stay are striking enough to justify it.'