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In pursuit of surgical success

Ensuring a safe operation for every patient is not straightforward. Surgical patients range from the gravely ill with a slim chance of survival to the perfectly healthy who are seeking enhancement. Given this highly variable mix, surgical safety can be problematic to define, difficult to implement and harder to measure. As the population ages and technological advances feed public expectations, surgeons may feel at risk of finding themselves in the situation described over a century ago by then professor of surgery at the University of Edinburgh, John Chiene: “The operation was a complete success, but the patient died of something else”.

As several commentators in this issue indicate, there has recently been renewed focus on this enduring surgical dilemma. In an overview of the expanding field of perioperative care (doi: 10.5694/mja13.10383), Waxman describes the ideal scenario, in which elective patients benefit from multidisciplinary preoperative assessment and an “enhanced recovery after surgery” pathway. Preoperative planning and a “preflight” checklist in the operating theatre pay dividends for patients in their postoperative journey, even in emergency surgery.