The Surgical clinics of North America
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Postoperative pulmonary complications (PPCs) occur frequently among general surgical patients. The spectrum of illness is broad and includes preventable causes of morbidity and death. Careful preoperative evaluation can identify undiagnosed and undertreated illness and allow for preoperative intervention. Optimization of patient, surgical, and anesthetic factors is crucial in the prevention of PPCs.
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Despite remarkable advances in the knowledge of infection and human response to it, sepsis continues to be one of the most common challenges surgeons and critical care providers face. Surgeons confront the problem of infection every day, in treating established infections or reacting to a consequence of surgical intervention. ⋯ Also, preventing nosocomial infection and antibiotic resistance is a primary responsibility. This article describes diagnostic and therapeutic measures for sepsis in the perioperative surgical patient.
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Perioperative nutrition is a vitally important yet often overlooked aspect of surgical care. Significant disparity exists between evidenced-based recommendations and practices encouraged by traditional surgical teaching. The metabolic response to surgical stress is complex. ⋯ Prehabilitation seeks to prepare patients for the impending surgical stress. Immunonutrition seems to provide a benefit, although its precise mechanisms are unknown. This article provides a review of the current state of perioperative nutrition.
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As the population ages, the health care system must to adapt to the needs of the older population. Hospitalization risks are particularly significant in the frail geriatric patients, with costly and morbid consequences. ⋯ Geriatric preoperative assessment expands usual risk stratification and careful medication review to include screening for functional disability, cognitive impairment, nutritional deficiency, and frailty. The information gathered can also equip the surgeon to develop a patient-centered and realistic treatment plan.
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Providing end-of-life care is a necessity for nearly all health care providers and especially those in surgical fields. Most surgical practices will involve caring for geriatric patients and those with life-threatening or terminal illnesses where discussions about end-of-life decision making and goals of care are essential. Understanding the differences between do not resuscitate (DNR), palliative care, hospice care, and symptom management in patients at the end of life is a critical skill set.