Do we really need postoperative ICU management after elective surgery? No, not any more!

Excerpt

A growing amount of evidence shows that postoperative complications are a dramatically relevant health issue estimated to cause 3–12 million deaths every year [1], resulting in one of the leading causes of mortality, even more lethal than road accidents or diabetes [2]. Hence, it is now acknowledged that more attention is needed to prevent, recognize early and treat any potentially life-threatening complication that might occur during the postoperative period. Accordingly, ICU admission of high-risk surgical patients has been historically regarded as of crucial importance to reduce the risk of perioperative death. However, with the increasing request for safe and effective medical provisions, a cost–efficacy analysis is mandatory to achieve these goals while avoiding any waste of the limited resources available, especially in low-income countries. Recently, the value of routine ICU admission after elective surgery has been questioned, given its costs and the lack of robust evidence supporting it [3, 4]. Moreover, identification of patients at highest risk, who might benefit from ICU admission, remains a major challenge leading to unacceptable inequity in resource distribution [5]. …