The first 24 hours after surgery

The first 24 hours of the postoperative course of 2153 consecutive patients who had operations at the Nottingham Hospitals were studied in detail. Five per cent of patients had serious complications during this period; 15% of those having major operations, 1.8% having intermediate operations and 1.4% having minor operations. Thus, a significant number of patients were in an unstable condition for many hours after they were discharged from the main theatre recovery areas to the surgical wards. In 17 out of 23 patients who died and six out of six patients who suffered severe disability as a result of their surgery, the final outcome was a direct result of a sequence of events which began with an initial deterioration within 24 hours of surgery. We considered that, for at least 10 of these 29 patients, the outcome might have been different had more sophisticated postoperative facilities been available. In the light of this study we have identified the operations for which high dependency facilities are most likely to be required.