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Correspondence  |   May 2014
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Author Affiliations & Notes
  • Suneetha Ramani Moonesinghe, F.R.C.A.
    University College London Hospitals NHS Foundation Trust, London, United Kingdom (S.R.M.). rmoonesinghe@gmail.com
  • Michael P. W. Grocott, M.D.
    University College London Hospitals NHS Foundation Trust, London, United Kingdom (S.R.M.). rmoonesinghe@gmail.com
  • (Accepted for publication January 28, 2014.)
    (Accepted for publication January 28, 2014.)×
Article Information
Correspondence
Correspondence   |   May 2014
In Reply
Anesthesiology 05 2014, Vol.120, 1297-1298. doi:10.1097/ALN.0000000000000215
Anesthesiology 05 2014, Vol.120, 1297-1298. doi:10.1097/ALN.0000000000000215
We thank Dr. Kehlet for his comments on our article.1  His letter raises important issues which we broadly agree with. The implementation of fast-track or “enhanced recovery” programs and the increasing use of minimally invasive surgical approaches are two examples of how surgical practice has changed in recent years, at least in some parts of the world. These may have impact on the risk of patient morbidity and mortality, particularly in the short term. Furthermore, improvements in the medical management of some chronic illnesses (e.g., ischemic heart disease) mean that the implications of such illnesses for patient health and perioperative prognostication are quite different today, compared with 20 yr ago when some of the risk-stratification tools featured in our systematic review were first developed and validated.
Thus, we agree that an approach to risk stratification is warranted which is responsive to such changes in practice and will also enable specialty-specific risks to be taken into consideration. The use of technology (such as mobile apps) and large datasets (“big data”) present opportunities to refine existing risk-stratification methodology for the modern era, leading to the development, validation, and regular reevaluation and recalibration of risk-prediction tools. However, the challenge of implementing the collection of such large datasets in a systematic manner remains significant in many healthcare systems outside the U.S. National Surgical Quality Improvement Program. The analysis of administrative data to achieve these goals may present a solution, but the accuracy and completeness of such data need evaluation in each healthcare setting where this is an option.
Competing Interests
The authors declare no competing interests.
Suneetha Ramani Moonesinghe, F.R.C.A., Michael P. W. Grocott, M.D. University College London Hospitals NHS Foundation Trust, London, United Kingdom (S.R.M.). rmoonesinghe@gmail.com
Reference
Reference
Moonesinghe, SR, Mythen, MG, Das, P, Rowan, KM, Grocott, MP Risk stratification tools for predicting morbidity and mortality in adult patients undergoing major surgery: Qualitative systematic review.. Anesthesiology. (2013). 119 959–1–81 [Article] [PubMed]