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Scottish Intercollegiate Guidelines Network

77

Postoperative management in adults
A practical guide to postoperative care for clinical staff

1 2 3 4 5 6 7 8 9

Introduction Clinical assessment and monitoring Cardiovascular management Respiratory management Fluid, electrolyte and renal management Management of sepsis Postoperative nutrition Information for discussion with patients andcarers Development of the guideline

1 3 11 20 28 34 39 44 45 48 49 52

Abbreviations Annexes References

August 2004

COPIES OF ALL SIGN GUIDELINES ARE AVAILABLE BY CALLING 0131 247 3664 OR ONLINE AT WWW.SIGN.AC.UK

KEY TO CONSENSUS AND EVIDENCE STATEMENTS
CONSENSUS STATEMENTS CS Statements developed from structured discussion, informed by any existing evidence and the group’sclinical experience, and validated using a formal scoring system.

LEVELS OF EVIDENCE 1++ 1+ 12
++

High quality meta-analyses, systematic reviews of randomised controlled trials (RCTs), or RCTs with a very low risk of bias Well conducted meta-analyses, systematic reviews of RCTs, or RCTs with a low risk of bias Meta-analyses, systematic reviews of RCTs, or RCTs with a high risk of bias High qualitysystematic reviews of case control or cohort studies High quality case control or cohort studies with a very low risk of confounding or bias and a high probability that the relationship is causal Well conducted case control or cohort studies with a low risk of confounding or bias and a moderate probability that the relationship is causal Case control or cohort studies with a high risk ofconfounding or bias and a significant risk that the relationship is not causal Non-analytic studies, eg case reports, case series Expert opinion

2+ 23 4

GRADES OF RECOMMENDATION Note: The grade of recommendation relates to the strength of the evidence on which the recommendation is based. It does not reflect the clinical importance of the recommendation. A At least one meta-analysis, systematicreview of RCTs, or RCT rated as 1++ and directly applicable to the target population; or A body of evidence consisting principally of studies rated as 1+, directly applicable to the target population, and demonstrating overall consistency of results B A body of evidence including studies rated as 2++, directly applicable to the target population, and demonstrating overall consistency of results; orExtrapolated evidence from studies rated as 1++ or 1+ C A body of evidence including studies rated as 2+, directly applicable to the target population and demonstrating overall consistency of results; or Extrapolated evidence from studies rated as 2++ D Evidence level 3 or 4; or Extrapolated evidence from studies rated as 2+

© Scottish Intercollegiate Guidelines Network
ISBN 1 899893 09 1 Firstpublished 2004 SIGN consents to the photocopying of this guideline for the purpose of implementation in NHSScotland Scottish Intercollegiate Guidelines Network Royal College of Physicians 9 Queen Street, Edinburgh EH2 1JQ www.sign.ac.uk
SIGN IS FUNDED BY NHS QUALITY IMPROVEMENT SCOTLAND

1 INTRODUCTION

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1.1

Introduction
THE NEED FOR GUIDANCE
Over the past five years, annual reportsfrom the Scottish Audit of Surgical Mortality (SASM) have highlighted problems in perioperative management of patients. These include failure to predict or recognise clinical decline, failure to involve consultants at an early stage and failure to appreciate the consequences of not acting promptly when decline is identified.1 SASM has consistently highlighted variation in practice in postoperativecare. Almost 2,000 patients die following surgery in Scotland each year. In the vast majority, death is the inevitable consequence of the disease process. However, it is likely that some 10,000 patients per year suffer major complications after surgery and “best practice” guidelines might have an impact in this area. As a consequence of these audits, SASM has called for the development of local...
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