Major surgery in high risk people produces large numbers of critically ill patients. But Dr Jonathan Wilson and colleagues from York District Hospital say appropriate pre-operative care may help to reduce rates of death and illness and even the length of their stay in hospital.

They studied 138 patients undergoing major non-emergency surgery, who were at risk of developing post-operative complications either due to the surgery itself or because of other medical conditions.

Most were either undergoing surgery for cancer, or for major blood vessel grafts.

Few receive intensive care

In the UK, most patients are taken from a general ward directly to the operating theatre before such surgery.

Only 5% of all planned non-emergency surgical admissions receive pre-operative intensive care.

The researchers, whose work is reported in the British Medical Journal, compared the outcome of patients who were treated in this normal way and of those who were given pre-operative treatment.

Major surgery can lead to complications

The pre-operative treatment consisted of measuring the patient's blood pressure and fluid levels, and tailoring treatment to ensure the best possible level of fluid and oxygen reached the tissues before surgery.

The researchers found that only 3% of those patients who had received treatment before their operation died.

This compared to 17% of those patients who did not receive pre-operative care.

Dr Wilson and his team conclude that even though a formal cost benefit analysis was not performed, the cost of providing pre-operative care would be offset by the the reduction in subsequent complications and length of hospital stay.

Dr Wilson said: "There was such a marked reduction in days spent in hospital that we calculated that it would save �2,500 for each patient treated in this way.

"If resources were made available to invest in high-dependency beds and skilled medical intervention it is quite likely that it would prevent many patients from developing complications and ending up back in intensive care in big trouble and costing a lot of money."

Massive resources required

Dr Gary Smith, director of intensive care at Queen Alexandra Hospital, Portsmouth, said there was a growing body of evidence to suggest that patients benefited from post-operative care.

However, he said it would take a huge injection of resources for existing intensive care facilities to offer such a service.

"At present we do not have enough intensive care beds to be able to offer pre-operative optimisation to the majority of our patients because our beds are occupied most of the time," he said.

"It might be possible to offer such a service given one or two additional beds, but if you add that up around the country the cost to the NHS would be phenomenal."

Dr Smith said even if beds were made available, it would prove difficult to recruit sufficient intensive care nurses to staff them.

However, he said there should be more public debate about whether resources should be made available given that a pre-operative service could in the long term save lives and money.