Perioperative management of challenging comorbid conditions

In the UK, increasing numbers of patients present for surgery with challenging comorbidities. Organizational changes within the UK NHS mean that patients with no or mild comorbid conditions are treated separately within elective care centres. Surgical teams working outside these centres are therefore likely to spend increasing amounts of time diagnosing and managing medical conditions. Perioperative management of comorbid conditions may represent a greater challenge than the surgery itself, and may be the most important determinant of a good outcome. Therefore, as well as developing surgical skills, trainees must quickly learn to manage many straightforward medical problems, and must also realize when referral is appropriate.