PubMed · 17204799
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Matthew J Peters. 2007-01-06. Should smokers be refused surgery?. https://doi.org/10.1136/bmj.39059.503495.68
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People are coming to harm due to deficiencies in the provision of both elective and acute care. New Zealand cannot provide care to all who might benefit, but it behoves us to use whatever resource we can afford to its maximum utility. Acute and elective patients share the same resource, and the overwhelming of the acute services is causing both acute and elective patients to suffer. To fix this requires that DHBs know how to, are able to, and want to fix the problem. To muster the knowledge and the ability, and to encourage the desire, we need a national acute care strategy. Consideration of three conceptual models gives us six principles guiding solutions to the problems in acute care provision. Combining these principles with meaningful performance measures and with strong incentives to perform, will form the basis of an acute care strategy.
Liver disease increases surgical risk. Thus, in patients with cirrhosis, the mortality after abdominal or heart surgery is 50-75% in Child-Pugh C, 20-30% in B and near normal in Child-Pugh A. Stable autoimmune hepatobiliary disease and steatosis without inflammation do not increase surgical risk, but the mortality after major abdominal surgery is increased in patients with fulminant hepatic failure (>90%), alcoholic hepatitis (50%) and acute viral hepatitis (10-15%).