LAUSR

Perioperative medicine involves a range of medical specialists, including anaesthetists, physicians and surgeons, and is expanding in response to the increasing need to prevent and manage postoperative complications. There have been few attempts to quantify the future burden of postoperative complications. However, data from the extensively validated American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database and risk prediction tool and data on Australian population projections provide an opportunity to estimate the future changes in Australia. For example, using colonic resection (Hartmann’s procedure), a procedure with a relatively high prevalence and complication rate, and a known response to optimal postoperative treatment, NSQIP 30-day predictions of the probability of readmission, serious postoperative complications, length of stay and death were calculated. The hypothetical patient was male, with hypertension and an American Society of Anesthesiologists (ASA) score of 2, and in the age brackets 65–74 years, 75–84 years and 85 years. These calculations show a substantial impact of age on complications, especially for death (see Figure 1). The predicted increases in the Australian population numbers in these age brackets between 2017 and 2047 Figure 1. Postoperative events after Hartmann’s procedure predicted by the National Surgical Quality Improvement Program (NSQIP) risk prediction algorithm for theoretical patients with hypertension and an American Society of Anesthesiologists score of 2, and in the age brackets of 65–74 years (dotted bars), 75–84 years (striped bars) and >85 years (solid bars).