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Of the millions of people who undergo surgery annually, most fare very well, perhaps feeling a bit weak, fatigued, or nauseous for a few hours after leaving the operating room. Unfortunately, many patients experience significant complications during or after surgery -- the perioperative period -- even if the operation itself is a success.

Many perioperative complications occur as a direct side effect of the drugs that anesthesiologists use to render a patient unconscious, including sedatives, analgesics, amnesics, and muscle relaxants. But complications can also stem from the various life-support measures and medications that are needed during surgery to control the patient's respiration, blood pressure, heart rate, fluid levels, and more. In sum, surgery puts extreme stress on all of the body's organ systems.

Older patients are especially prone to perioperative complications, They also stand a higher chance of dying during surgery or recovery. Other risk factors for perioperative complications, in addition to advanced age, include frailty, severe illness, and co-morbidities, or concurrent health problems.

While the complications of surgery and anesthesia can be obvious and dramatic, like severe nausea or heart attack, they can also be subtle and hard to categorize. Indeed, many, if not most, of us know a friend or family member who wasn’t "quite right" after an operation, eliciting such observations as: "He’s become so forgetful" or "She can’t concentrate on anything."

For in-depth reading about perioperative complications and anesthesia, see:
*   "Cognitive function after anesthesia in the elderly" (Best Practice
     & Research Clinical Anaesthesiology) abstract
*   "Perioperative Complications in Elderly Patients" (American
     Society of Anesthesiologists) article
*   "Preventing perioperative complications in an older adult"
     (Nursing) article
*   "Perioperative care of the elderly patient" (Cleveland Clinic)
     article (PDF)
*   "Understanding Anesthesia" (NYU Physician) article

A growing medical, economic, and social problem

The practice of anesthesiology remains very much an art and a science. In putting a patient to sleep, the anesthesiologist administers a cocktail of a half-dozen or more drugs that is never the same for any two people and difficult to predict beforehand. As the operation unfolds, the anesthesiologist adjusts dosages and adds new drugs to the mix in response to changes in vital signs, all the while charting a safe course between administering too much and too little medication.

Recent advances in surgical techniques and anesthetic care have significantly reduced the risks of surgery. Ironically, these advances have actually increased the overall incidence of perioperative complications. Now, seriously ill patients, including those with multiple medical problems, are able to undergo complex surgical procedures, even relatively late in life. Since these are the very patients who are most likely to have problems during or after surgery, perioperative complications are becoming more commonplace.

With the aging of the population, this trend has significant economic and social implications. In the years ahead, the care of patients with perioperative complications will consume a larger and larger share of our limited health resources, putting further stress on the health-care system as well as on family caregivers, who provide the bulk of the care for the elderly, chronically ill, and disabled.

Little funding available for perioperative research

Relatively little is known about the biological mechanisms that underlie perioperative complications, and there are few prospects for learning more in the years ahead. A small amount of funding is allocated to research into perioperative complications. The major reason is that these complications are a sprawling set of medical problems as opposed to a specific disease. Most funding for medical research in the U.S. comes from the National Institutes of Health (NIH), private foundations, and the pharmaceutical industry. The NIH tends to focus on understanding diseases at the cellular, molecular, and genetic levels. Private philanthropies usually have a broader mission, but their work also targets specific diseases, like AIDS or Alzheimer’s. Meanwhile, drug makers concentrate on the development of medications for specific diseases. As a result, research into perioperative complications falls through the cracks.

The Center’s mission is to address this oversight by supporting both basic and clinical research into perioperative complications. Our aim is to learn more about the biology of perioperative complications, and using this knowledge, devise better ways to predict who will suffer complications, to reduce and treat complications, and ultimately, to prevent such complications from occurring in the first place.