Another inconvenient truth: meeting the challenge of preventing poor surgical outcomes.

The high-risk noncardiac surgical population represents a major global healthcare challenge. Despite widespread advances in medical care, surgery remains a common and effective treatment option for a diverse range of diseases. Far from being replaced by drug therapies, the role of surgical treatment options appears to be growing. Moreover, surgery is now more frequently deemed a viable option for elderly patients and those with comorbidities or advanced disease. Recent estimates suggest that 234 million major surgical procedures are performed worldwide each year [1]. Whereas this estimate may be on the high side because of the broad definition of major surgery, there is little doubt that a very large number of patients undergo potentially life-threatening surgery. The topics covered in this edition of the journal have been carefully selected for their relevance to recent advances in the delivery of perioperative care. Despite the many opportunities to apply such advances in clinical practice to improve surgical outcomes, this knowledge base is poorly recognized and exploited. There is a widespread failure to acknowledge the frequency of poor outcomes after surgery, to search for effective preventive and therapeutic measures and to implement research findings where appropriate. The aim of this editorial is to highlight the major challenges we must tackle to increase patient survival through improved perioperative care.