The author emphasizes the need for proactive preoperative optimization rather than just reactive postoperative management to reduce morbidity and mortality in noncardiac surgery.
To the Editor. —I read with great interest the Editorial1dealing with risks associated with major noncardiac surgery. Great strides have already been made in (1) identification of patients who are at greater risk for morbidity and mortality in the perioperative period, (2) application of improved monitoring, and (3) earlier and more effective intervention when problems occur. However, if all that our identifiers and indicators do is heighten our awareness so that we are more ready to react with our antihypertensives, anti-ischemics, antiarrhythmics, and anti—this-and-thats, then we are not likely to make further significant improvements in postoperative morbidity and mortality statistics. Along with improved monitoring and readiness to react, we must redouble our efforts to be more proactive. Killip points out that the patient is at greatest risk during the postoperative period. The preoperative period allows us to identify patients' surgical and medical problems and to tune up patients
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Charles Gregorius (1993) studied this question.
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