ABSTRACT
An important component to successful surgical intervention is appropriate postoperative management. It is imperative that prior to commencing surgery, one understands the capability of the hospital, including staffing, resources, and facilities available. This includes the availability of a patient recovery area or an intensive care unit, the bed capacity, the nursing staffing capabilities, and what resources are available (i.e., patient monitors, mechanical ventilators, blood products). In many hospitals in the less developed world, only ward care is available and the nursing to patient ratio is quite high. Therefore, a patient cannot be expected to receive frequent assessment or ongoing fluid resuscitation in this setting. It could possibly be the case that the capability exists to perform the procedure, but there are not appropriate staff and/or resources to safely care for the patient postoperatively. In this setting, referral may be the best and safest alternative. Many hospitals do not have a blood bank or mechanisms to separate blood products. Thus, blood is often directly donated from family members or staff when needed, and only whole blood might be available. Infection screening processes may be limited, if available at all. Thus, performing a surgery with significant expected blood loss may not be possible unless an appropriate amount of blood can be procured and stored for use during surgery and postoperatively.
