Randomized evidence for reduction of perioperative mortality

Giovanni Landoni, Reitze N. Rodseth, Francesco Santini, Martin Ponschab, Laura Ruggeri, Andrea Székely, Daniela Pasero, John G. Augoustides, Paolo A. Del Sarto, Lukasz J. Krzych, Antonio Corcione, Alexandre Slullitel, Luca Cabrini, Yannick Le Manach, Rui M S Almeida, Elena Bignami, Giuseppe Biondi-Zoccai, Tiziana Bove, Fabio Caramelli, Claudia CarielloAnna Carpanese, Luciano Clarizia, Marco Comis, Massimiliano Conte, Remo D. Covello, Vincenzo De Santis, Paolo Feltracco, Gianbeppe Giordano, Demetrio Pittarello, Leonardo Gottin, Fabio Guarracino, Andrea Morelli, Mario Musu, Giovanni Pala, Laura Pasin, Ivana Pezzoli, Gianluca Paternoster, Rossella Remedi, Agostino Roasio, Mariachiara Zucchetti, Flavia Petrini, Gabriele Finco, Marco Ranieri, Alberto Zangrillo

Research output: Contribution to journalArticlepeer-review


Objective: With more than 220 million major surgical procedures performed annually, perioperative interventions leading to even minor mortality reductions would save thousands of lives per year. This international consensus conference aimed to identify all nonsurgical interventions that increase or reduce perioperative mortality as suggested by randomized evidence. Design and Setting: A web-based international consensus conference. Participants: More than 1,000 physicians from 77 countries participated in this web-based consensus conference. Interventions: Systematic literature searches (MEDLINE/PubMed, June 8, 2011) were used to identify the papers with a statistically significant effect on mortality together with contacts with experts. Interventions were considered eligible for evaluation if they (1) were published in peer-reviewed journals, (2) dealt with a nonsurgical intervention (drug/technique/strategy) in adult patients undergoing surgery, and (3) provided a statistically significant mortality increase or reduction as suggested by a randomized trial or meta-analysis of randomized trials. Measurements and Main Results: Fourteen interventions that might change perioperative mortality in adult surgery were identified. Interventions that might reduce mortality include chlorhexidine oral rinse, clonidine, insulin, intra-aortic balloon pump, leukodepletion, levosimendan, neuraxial anesthesia, noninvasive respiratory support, hemodynamic optimization, oxygen, selective decontamination of the digestive tract, and volatile anesthetics. In contrast, aprotinin and extended-release metoprolol might increase mortality. Conclusions: Future research and health care funding should be directed toward studying and evaluating these interventions.

Original languageEnglish
Pages (from-to)764-772
Number of pages9
JournalJournal of Cardiothoracic and Vascular Anesthesia
Issue number5
Publication statusPublished - Oct 2012


  • anesthesia
  • consensus
  • mortality
  • perioperative
  • randomized
  • surgery

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Anesthesiology and Pain Medicine


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