179:
such as atelectasis, bronchospasm, laryngospasm, and unanticipated need for supplemental oxygen therapy after the initial postoperative period.) Of all patient-related risk factors, good evidence supports patients with advanced age, ASA class II or greater, functional dependence, chronic obstructive pulmonary disease, and congestive heart failure, as those with increased risk for PPC. Of operative risk factors, surgical site is the most important predictor of risk for PPCs (aortic, thoracic, and upper abdominal surgeries being the highest-risk procedures, even in healthy patients. The value of preoperative testing, such as spirometry, to estimate pulmonary risk is of controversial value and is debated in medical literature. Among laboratory tests, a serum albumin level less than 35 g/L is the most powerful predictor and predicts PPC risk to a similar degree as the most important patient-related risk factors.
275:
development index (HDI) countries even when adjusted for prognostic factors. In this study the overall global mortality rate was 1·6 per cent at 24 hours (high HDI 1·1 per cent, middle HDI 1·9 per cent, low HDI 3·4 per cent), increasing to 5·4 per cent by 30 days (high HDI 4·5 per cent, middle HDI 6·0 per cent, low HDI 8·6 per cent; P < 0·001). A sub-study of 1,409 children undergoing emergency abdominal surgery from 253 centres across 43 countries found that adjusted mortality in children following surgery may be as high as 7 times greater in low-HDI and middle-HDI countries compared with high-HDI countries. This translate to 40 excess deaths per 1000 procedures performed in these settings. Patient safety factors were suggested to play an important role, with use of the
263:.. Although in some high-resource health care systems, statistics are kept by mandatory reporting of perioperative mortality, this is not done in most countries. For this reason a figure for total global perioperative mortality can only be estimated. A study based on extrapolation from existing data sources estimated that 4.2 million people die within 30 days of surgery every year, with half of these deaths occurring in low- and middle-income countries.
107:
Methods to decrease surgical site infections in spine surgery include the application of antiseptic skin preparation (a.g. Chlorhexidine gluconate in alcohol which is twice as effective as any other antiseptic for reducing the risk of infection), use of surgical drains, prophylactic antibiotics, and
178:
Many factors can influence the risk of postoperative pulmonary complications (PPC). (A major PPC can be defined as a postoperative pneumonia, respiratory failure, or the need for reintubation after extubation at the end of an anesthetic. Minor post-operative pulmonary complications include events
328:
The current mortality attributable to the management of general anesthesia is controversial. Most current estimates of perioperative mortality range from 1 death in 53 anesthetics to 1 in 5,417 anesthetics. The incidence of perioperative mortality that is directly attributable to anesthesia ranges
274:
Globally, there are few studies comparing perioperative mortality across different health systems. One prospective study of 10,745 adult patients undergoing emergency abdominal surgery from 357 centres across 58 countries found that mortality is three times higher in low- compared with high-human
270:
that compare the quality of hospitals. Critics of this system point out that perioperative mortality may not reflect poor performance but could be caused by other factors, e.g. a high proportion of acute/unplanned surgery, or other patient-related factors. Most hospitals have regular meetings to
37:, regardless of cause, occurring within 30 days after surgery in or out of the hospital. Globally, 4.2 million people are estimated to die within 30 days of surgery each year. An important consideration in the decision to perform any surgical procedure is to weigh the benefits against the risks.
349:
The largest study of postoperative mortality was published in 2010. In this review of 3.7 million surgical procedures at 102 hospitals in the
Netherlands during 1991 – 2005, postoperative mortality from all causes was observed in 67,879 patients, for an overall rate of 1.85%.
84:
Countries with a low human development index (HDI) carry a disproportionately greater burden of surgical site infections (SSI) than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of the World Health
Organization (WHO) recommendations on SSI
345:
with specialized training in anesthesia administered the general anesthetic or deep sedation. The authors calculated an overall mortality rate of 1.4 per 1,000,000. It is suggested that these wide ranges may be caused by differences in operational definitions and reporting sources.
121:
aimed to assess the effects of strict blood glucose control around the time of operation to prevent SSIs. The authors concluded that there was insufficient evidence to support the routine adoption of this practice and that more
1898:
de Leon MP, Pezzi A, Benatti P, Manenti A, Rossi G, di
Gregorio C, Roncucci L (July 2009). "Survival, surgical management and perioperative mortality of colorectal cancer in the 21-year experience of a specialised registry".
1109:
Fitzgerald JE, Khatri C, Glasbey JC, Mohan M, Lilford R, Harrison EM, et al. (GlobalSurg
Collaborative) (July 2016). "Mortality of emergency abdominal surgery in high-, middle- and low-income countries".
709:"Groin Wound Infection after Vascular Exposure (GIVE) Risk Prediction Models: Development, Internal Validation, and Comparison with Existing Risk Prediction Models Identified in a Systematic Literature Review"
542:"Groin Wound Infection after Vascular Exposure (GIVE) Risk Prediction Models: Development, Internal Validation, and Comparison with Existing Risk Prediction Models Identified in a Systematic Literature Review"
85:
prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication.
1017:
Smetana GW, Lawrence VA, Cornell JE (April 2006). "Preoperative pulmonary risk stratification for noncardiothoracic surgery: systematic review for the
American College of Physicians".
768:"The Comparative Efficacy of Chlorhexidine Gluconate and Povidone-iodine Antiseptics for the Prevention of Infection in Clean Surgery: A Systematic Review and Network Meta-analysis"
45:
employ various methods in assessing whether a patient is in optimal condition from a medical standpoint prior to undertaking surgery, and various statistical tools are available.
540:
Gwilym BL, Ambler GK, Saratzis A, Bosanquet DC, Stather P, Singh A, Mancuso E, Arifi M, Altabal M, Elhadi A, Althini A, Ahmed H, Davies H, Rangaraju M, Juszczak M (August 2021).
305:
In a 1954 review of 599,548 surgical procedures at 10 hospitals in the United States between 1948 – 1952, 384 deaths were attributed to anesthesia, for an overall
807:
Pahys JM, Pahys JR, Cho SK, Kang MM, Zebala LP, Hawasli AH, et al. (March 2013). "Methods to decrease postoperative infections following posterior cervical spine surgery".
707:
Gwilym BL, Ambler GK, Saratzis A, Bosanquet DC, Stather P, Singh A, Mancuso E, Arifi M, Altabal M, Elhadi A, Althini A, Ahmed H, Davies H, Rangaraju M, Juszczak M (2021-08-01).
2157:
648:
Gwilym BL, Dovell G, Dattani N, Ambler GK, Shalhoub J, Forsythe RO, Benson RA, Nandhra S, Preece R, Onida S, Hitchman L, Coughlin P, Saratzis A, Bosanquet DC (2021-04-01).
601:"Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study"
353:
Anaesthesiologists are committed to continuously reducing perioperative mortality and morbidity. In 2010, the principal
European anaesthesiology organisations launched
2122:
1767:
Johnson ML, Gordon HS, Petersen NJ, Wray NP, Shroyer AL, Grover FL, Geraci JM (January 2002). "Effect of definition of mortality on hospital profiles".
391:
Johnson ML, Gordon HS, Petersen NJ, Wray NP, Shroyer AL, Grover FL, Geraci JM (January 2002). "Effect of definition of mortality on hospital profiles".
271:
discuss surgical complications and perioperative mortality. Specific cases may be investigated more closely if a preventable cause has been identified.
650:"Editor's Choice – Systematic Review and Meta-Analysis of Wound Adjuncts for the Prevention of Groin Wound Surgical Site Infection in Arterial Surgery"
1344:
371:
354:
329:
from 1 in 6,795 to 1 in 200,200 anesthetics. There are some studies however that report a much lower mortality rate. For example, a 1997 Canadian
1389:"A study of the deaths associated with anesthesia and surgery: based on a study of 599, 548 anesthesias in ten institutions 1948-1952, inclusive"
499:
314:
1474:
111:
Whether any specific dressing has an effect on the risk of surgical site infection of a wound that has been sutured closed is unclear.
295:
1165:"Determinants of morbidity and mortality following emergency abdominal surgery in children in low-income and middle-income countries"
309:
of 0.064%. In 1984, after a television program highlighting anesthesia mishaps aired in the United States, American anesthesiologist
599:
Bhangu A, Ademuyiwa AO, Aguilera ML, Alexander P, Al-Saqqa SW, Borda-Luque G, et al. (GlobalSurg
Collaborative) (May 2018).
1814:"Refining the definition of perioperative mortality following hepatectomy using death within 90 days as the standard criterion"
239:, wound infection, etc. However, in the early post-operative period a low-level fever may also result from anaesthetic-related
325:
was created in 1985 as an independent, nonprofit corporation with the vision that "no patient shall be harmed by anesthesia".
338:
1440:
276:
167:
2012:"Acp. Best practice no 155. Pathological investigation of deaths following surgery, anaesthesia, and medical procedures"
151:
123:
79:
2105:
2055:"Defining perioperative mortality after open and endovascular aortic aneurysm repair in the US Medicare population"
330:
231:
are a common complication after surgery and can be a hallmark of a serious underlying sepsis, such as pneumonia,
1555:
2152:
337:
procedures in
Ontario between 1973 – 1995 reported only four deaths in cases in which either an
1507:"Anesthesia safety: model or myth? A review of the published literature and analysis of current original data"
1132:
465:
1645:"Postoperative mortality in The Netherlands: a population-based analysis of surgery-specific risk in adults"
1163:
Ademuyiwa AO, Arnaud AP, Drake TM, Fitzgerald JE, Poenaru D, et al. (GlobalSurg
Collaborative) (2016).
252:
232:
115:
97:
2162:
163:
310:
1554:
Arbous MS, Meursing AE, van Kleef JW, de Lange JJ, Spoormans HH, Touw P, et al. (February 2005).
735:
676:
568:
283:
236:
135:
2147:
282:
Mortality directly related to anesthetic management is less common, and may include such causes as
228:
182:
2053:
Schermerhorn ML, Giles KA, Sachs T, Bensley RP, O'Malley AJ, Cotterill P, Landon BE (March 2011).
1924:
1800:
1784:
1536:
1145:
1091:
1042:
996:
416:
139:
313:
appointed a committee called the
Anesthesia Patient Safety and Risk Management Committee of the
302:. A 1978 study found that 82% of preventable anesthesia mishaps were the result of human error.
2116:
2084:
2041:
1998:
1953:
1916:
1886:
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988:
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824:
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748:
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689:
681:
630:
581:
573:
495:
470:
408:
299:
155:
118:
928:"Peri-operative glycaemic control regimens for preventing surgical site infections in adults"
877:
Dumville JC, Gray TA, Walter CJ, Sharp CA, Page T, Macefield R, et al. (December 2016).
142:, the risk of which can be mitigated by certain interventions, such as the administration of
2167:
2074:
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2031:
2023:
1988:
1978:
1945:
1908:
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1833:
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563:
553:
460:
450:
400:
217:
93:
38:
317:. This committee was tasked with determining and reducing the causes of peri-anesthetic
2079:
2054:
1993:
1966:
1936:
Shaw CD (1990). "Perioperative and perinatal death as measures for quality assurance".
1881:
1856:
1838:
1813:
1750:
1741:
1725:
1707:
1690:
1413:
1388:
1279:
1254:
1189:
1164:
948:
927:
903:
878:
625:
600:
366:
306:
193:, which occurs especially in patients recovering from thoracic and abdominal surgery..
17:
2070:
2036:
2011:
1621:
616:
455:
438:
2141:
1829:
1780:
1574:
1523:
1506:
1404:
1361:
404:
143:
2104:
Perioperative Mortality Review Committee, Department of Health, New Zealand (2009).
1928:
1812:
Mayo SC, Shore AD, Nathan H, Edil BH, Hirose K, Anders RA, et al. (July 2011).
1804:
1540:
1149:
1095:
420:
1643:
Noordzij PG, Poldermans D, Schouten O, Bax JJ, Schreiner FA, Boersma E (May 2010).
1556:"Impact of anesthesia management characteristics on severe morbidity and mortality"
1062:"Postoperative pulmonary complications: an update on risk assessment and reduction"
1046:
1000:
939:
894:
842:
James M, Martinez EA (September 2008). "Antibiotics and perioperative infections".
334:
267:
101:
1726:"Long-term survival is superior after resection for cancer in high-volume centers"
1475:"Uncle Sam, Anesthesia-Related Mortality and New Directions: Uncle Sam Wants You!"
1661:
1644:
1444:
1320:
1303:
984:
971:
Cook MW, Lisco SJ (2009). "Prevention of postoperative pulmonary complications".
784:
767:
516:"Overview | Surgical site infections: prevention and treatment | Guidance | NICE"
96:
are often given in abdominal surgery or patients known to have a heart defect or
291:
260:
240:
190:
1949:
725:
708:
666:
649:
558:
541:
1912:
1872:
1180:
855:
744:
685:
577:
1983:
1610:
Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics
342:
213:
186:
46:
2088:
2045:
2002:
1920:
1847:
1796:
1759:
1670:
1590:
1532:
1422:
1329:
1288:
1239:
1230:
1213:
1198:
1141:
1087:
1038:
992:
957:
912:
863:
828:
793:
752:
693:
634:
585:
489:
474:
412:
1957:
1890:
1716:
1629:
1270:
1078:
1061:
357:, a practically based manifesto for improving anaesthesia care in Europe.
2027:
1370:
820:
515:
287:
147:
58:
1459:
766:
Wade RG, Burr NE, McCauley G, Bourke G, Efthimiou O (1 September 2020).
1788:
1606:"Mortality incidence in outpatient anesthesia for dentistry in Ontario"
437:
Nepogodiev D, Martin J, Biccard B, Makupe A, Bhangu A (February 2019).
318:
159:
89:
62:
42:
1582:
1123:
2106:"Terms of Reference for the Perioperative Mortality Review Committee"
432:
430:
256:
201:
1689:
Deans GT, Odling-Smee W, McKelvey ST, Parks GT, Roy DA (July 1987).
34:
1967:"Surgery for hip fractures: Does surgical delay affect outcomes?"
1724:
Fong Y, Gonen M, Rubin D, Radzyner M, Brennan MF (October 2005).
1443:. Narberth, Pennsylvania: Physician's News Digest. Archived from
491:
Global guidelines for the prevention of surgical site infection
2131:"National Confidential Enquiry into Patient Outcome and Death"
355:
The Helsinki Declaration for Patient Safety in Anaesthesiology
88:
Local infection of the operative field is prevented by using
2130:
1304:"Anaphylaxis and anesthesia: controversies and new insights"
108:
vancomycin. Preventative antibiotics may also be effective.
57:
Immediate complications during the surgical procedure, e.g.
1343:
Cooper JB, Newbower RS, Long CD, McPeek B (December 1978).
1345:"Preventable anesthesia mishaps: a study of human factors"
1462:. Indianapolis, IN: Anesthesia Patient Safety Foundation.
1214:"Pulmonary aspiration of gastric contents in anaesthesia"
879:"Dressings for the prevention of surgical site infection"
1302:
Dewachter P, Mouton-Faivre C, Emala CW (November 2009).
204:
occur at a higher rate during the postoperative period.
1012:
1010:
322:
1965:
Simunovic N, Devereaux PJ, Bhandari M (January 2011).
844:
Best Practice & Research. Clinical Anaesthesiology
809:
The Journal of Bone and Joint Surgery. American Volume
713:
European Journal of Vascular and Endovascular Surgery
654:
European Journal of Vascular and Endovascular Surgery
546:
European Journal of Vascular and Endovascular Surgery
266:
Perioperative mortality figures can be published in
321:and mortality. An outgrowth of this committee, the
1695:Annals of the Royal College of Surgeons of England
216:, the perioperative mortality is predicted by the
1434:
1432:
1133:20.500.11820/7c4589f5-7845-4405-a384-dfb5653e2163
926:Kao LS, Meeks D, Moyer VA, Lally KP (July 2009).
466:20.500.11820/6088a4db-74af-4cc7-9ff4-21eb83da8d88
251:Most perioperative mortality is attributable to
27:Any death occurring within 30 days after surgery
294:. These in turn may result from malfunction of
259:, and failure of vital organs) or pre-existing
126:were needed to address this research question.
1500:
1498:
1496:
279:associated with reduced mortality at 30 days.
8:
2121:: CS1 maint: multiple names: authors list (
1857:"NCEPOD: revisiting perioperative mortality"
2059:Journal of the American College of Surgeons
1901:International Journal of Colorectal Disease
1212:Engelhardt T, Webster NR (September 1999).
932:The Cochrane Database of Systematic Reviews
883:The Cochrane Database of Systematic Reviews
2158:Complications of surgical and medical care
1604:Nkansah PJ, Haas DA, Saso MA (June 1997).
2078:
2035:
1992:
1982:
1880:
1837:
1749:
1706:
1660:
1522:
1412:
1360:
1319:
1278:
1255:"Maternal death from aspiration asphyxia"
1229:
1188:
1131:
1077:
947:
902:
783:
736:1983/8e17b0f2-2b9e-4c7f-947b-82f0535b1ffb
734:
724:
677:1983/47254b47-dcd3-4819-9cee-5c22a7ce7b04
675:
665:
624:
569:1983/8e17b0f2-2b9e-4c7f-947b-82f0535b1ffb
567:
557:
464:
454:
372:ASA physical status classification system
61:or perforation of organs may have lethal
1031:10.7326/0003-4819-144-8-200604180-00009
383:
243:, which will usually resolve normally.
2114:
439:"Global burden of postoperative death"
255:from the operation (such as bleeding,
2010:Start RD, Cross SS (September 1999).
315:American Society of Anesthesiologists
7:
1066:Cleveland Clinic Journal of Medicine
973:International Anesthesiology Clinics
323:Anesthesia Patient Safety Foundation
168:cyclical pneumatic calf compression
1742:10.1097/01.sla.0000184190.20289.4b
1691:"Auditing perioperative mortality"
25:
2071:10.1016/j.jamcollsurg.2010.12.003
49:is the most well known of these.
1938:Quality Assurance in Health Care
1830:10.1111/j.1477-2574.2011.00326.x
1781:10.1097/00005650-200201000-00003
1575:10.1097/00000542-200502000-00005
1524:10.1097/00000542-200212000-00038
1405:10.1097/00000658-195407000-00001
1362:10.1097/00000542-197812000-00004
405:10.1097/00005650-200201000-00003
605:The Lancet. Infectious Diseases
100:that are at risk of developing
69:Complications following surgery
1971:Indian Journal of Orthopaedics
1736:(4): 540–4, discussion 544–7.
1218:British Journal of Anaesthesia
1112:The British Journal of Surgery
940:10.1002/14651858.cd006806.pub2
895:10.1002/14651858.CD003091.pub4
339:oral and maxillofacial surgeon
1:
2016:Journal of Clinical Pathology
1622:10.1016/S1079-2104(97)90312-7
1441:"Improving anesthesia safety"
617:10.1016/S1473-3099(18)30101-4
494:. World Health Organization.
456:10.1016/S0140-6736(18)33139-8
277:WHO Surgical Safety Checklist
152:low molecular weight heparins
1662:10.1097/ALN.0b013e3181d5f95c
1505:Lagasse RS (December 2002).
1321:10.1097/ALN.0b013e3181bbd443
1060:Smetana GW (November 2009).
985:10.1097/aia.0b013e3181ba1406
785:10.1097/SLA.0000000000004076
296:anesthesia-related equipment
124:randomized controlled trials
1019:Annals of Internal Medicine
80:Hospital-acquired infection
2184:
726:10.1016/j.ejvs.2021.05.009
667:10.1016/j.ejvs.2020.11.053
559:10.1016/j.ejvs.2021.05.009
185:has a place in preventing
77:
1913:10.1007/s00384-009-0687-1
1873:10.1136/bmj.304.6835.1128
1569:(2): 257–68, quiz 491–2.
1181:10.1136/bmjgh-2016-000091
856:10.1016/j.bpa.2008.05.001
1950:10.1093/intqhc/2.3-4.235
488:Organization WH (2018).
94:prophylactic antibiotics
33:has been defined as any
1984:10.4103/0019-5413.73660
1387:, Todd DP (July 1954).
1259:British Medical Journal
1253:Parker RB (July 1956).
233:urinary tract infection
170:in high risk patients.
98:mechanical heart valves
31:Perioperative mortality
18:Pulmonary complications
1855:Nixon SJ (May 1992).
1458:Stoelting RK (2010).
1439:Guadagnino C (2000).
1271:10.1136/bmj.2.4983.16
1079:10.3949/ccjm.76.s4.10
286:of gastric contents,
164:compression stockings
53:Intraoperative causes
2028:10.1136/jcp.52.9.640
1473:Cottrell JE (2003).
1460:"Foundation History"
1231:10.1093/bja/83.3.453
821:10.2106/JBJS.K.00756
331:retrospective review
284:pulmonary aspiration
237:deep vein thrombosis
229:Postoperative fevers
136:deep vein thrombosis
1485:(1). Archived from
224:Postoperative fever
183:Respiratory therapy
1072:(Suppl 4): S60-5.
298:or more commonly,
261:medical conditions
208:Livers and kidneys
156:antiplatelet drugs
140:pulmonary embolism
1730:Annals of Surgery
1393:Annals of Surgery
1169:BMJ Global Health
1124:10.1002/bjs.10151
772:Annals of Surgery
501:978-92-4-155047-5
311:Ellison C. Pierce
119:systematic review
90:sterile technique
39:Anesthesiologists
16:(Redirected from
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2039:
2006:
1996:
1986:
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1884:
1867:(6835): 1128–9.
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889:(12): CD003091.
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787:
778:(6): e481–e488.
763:
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388:
218:Child-Pugh score
21:
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2153:Causes of death
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2100:
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2009:
1964:
1944:(3–4): 235–41.
1935:
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1682:Further reading
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1511:Anesthesiology
1492:
1489:on 2010-07-31.
1479:ASA Newsletter
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1447:on 2010-08-15.
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1349:Anesthesiology
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1308:Anesthesiology
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2163:Epidemiology
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102:endocarditis
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399:(1): 7–16.
300:human error
292:anaphylaxis
241:atelectasis
191:atelectasis
189:related to
130:Blood clots
2148:Anesthesia
2142:Categories
1583:1874/12590
1385:Beecher HK
526:2023-11-16
378:References
197:Neurologic
745:1078-5884
686:1078-5884
578:1078-5884
319:morbidity
214:cirrhosis
187:pneumonia
74:Infection
47:ASA score
2117:cite web
2089:21296011
2046:10655984
2003:21221220
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148:warfarin
116:Cochrane
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2168:Surgery
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341:or a
174:Lungs
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