Dissertation for the degree of philosophiae doctor ( PhD ) at the University of Bergen

Background: Postoperative complications are frequent causes of postoperative mortality. Such complications may also lead to a prolonged period with decreased functional and cognitive status. Perioperative care is a factor in postoperative morbidity and mortality. Until now no common international definitions and classifications of postoperative complications have been established. The group of surgical patients with the highest risk of postoperative complications accounts for perhaps 80% of intra-hospital deaths. With the high volume of surgery performed worldwide, even a slight reduction in complications would result in a lower number of preventable deaths. There are several theories on how to decrease postoperative complications and improve patient safety and patient care. Two factors, checklists and perioperative fluid balance, are investigated in this thesis. The overall aim of this thesis is twofold: 1. To study perioperative complications and outcome after major surgery Paper I aimed at creating standard definitions of outcome measures for use in pragmatic large perioperative clinical trials. Paper II aimed at providing data on perioperative mortality after non-cardiac surgery across Europe. 2. To contribute in finding ways to reduce complications after major surgery Paper III aimed at identifying the prevalence of surgical checklist use and possible relationship with mortality. Paper IV aimed at evaluating the effect of perioperative goal directed fluid therapy guided by ScvO2 in open colorectal surgery. Result: Paper I was a literature review to assess the current state of knowledge about surgical outcome definitions. A standardized list was created for use in perioperative research and clinical audition. The outcome measures described are organized into four different categories: Individual adverse events, Composite outcomes, Grading of complications and Health related quality of life.