Читать книгу Complications in Equine Surgery - Группа авторов - Страница 16

 Morbidity and mortality

 Surgical checklists

 Perioperative consequences of surgical trauma

 Metabolic and nutritional effects

 Neuroendocrine

 Systemic inflammatory response

 Pain

 Impact of host factors and comorbid conditions

“Surgical complications,” otherwise referred to as “operative complications,” are not restricted to the time window of the surgical procedure itself but comprise both intra‐ and postoperative complications [2]. The duration of surgery defines the time window for intraoperative complications; meanwhile, postoperative complications are not restricted to those occurring during hospitalization but are defined according to a time period. A 30‐day period after the surgical procedure, either during or after hospitalization, has been used in human medicine [2].

All surgical procedures are associated with a degree of risk and the benefits of any procedure need to be weighed against any potential complications so that the clinician and the patient or animal owner can make a balanced and informed decision. This discussion should also cover complementary techniques that augment results to optimize physical, occupational and societal goals [3]. In veterinary medicine, owners’ expectations, engagement and commitment, animal welfare and economics need also to be balanced.

Surgical complications can be classified into patient‐related complications (related to patient‐specific characteristics, rather than to a procedural error), and practitioner‐related complications (arising from errors that directly lead to undesirable and unintended results affecting the patient, but also as a result of a faulty technique) [3]. Although surgical errors may be frequently linked to complications, some errors may not result in complications.

Recognition of errors and complications provide unique instances to learn from and to work toward avoiding or preventing their re‐occurrence [4]. To maximize this process the following practitioner's goals have been defined in human medicine [3, 5]:

1 Minimize errors by applying an appropriate surgical technique.

2 Identify and manage errors in a timely manner and in a way that would prevent ensuing complications.

3 Identify and manage complications in a timely manner and appropriately.

4 Identify and consider patient‐related complications in the decision‐making process, so that they can be anticipated, prevented or managed correctly.

It is not uncommon for clinicians to adopt routines that prevent and manage complications on the basis of personal experience. However, in some cases this may be associated with “making the same mistakes with increasing confidence over an impressive number of years” [6]. In human medicine, standards of expected outcomes for groups of patients require evidence‐based practice, making seniority and individual experience less important [7]. Evidence‐based literature in this area has quickly developed over the last decades, and several textbooks and journals dedicated to surgical complications are available in the human field. The application of an evidence‐based approach for prevention, identification and management of surgical complications should result in a reduction in mistakes in the clinical decision‐making process. In addition, it will also identify areas on which further research is warranted.