From Cuthbertson to fast-track surgery: 70 years of progress in reducing stress in surgical patients

Abstract

Objective: To evaluate the evolution of knowledge concerning the stress response in surgical patients and to determine the therapeutic benefit of stress reduction therapy.

Summary background data: The stress response in surgical patients is associated with tissue catabolism, organ failure, and prolonged recovery. Understanding the neural-hormonal basis for these events has stimulated efforts to attenuate these undesirable effects. A review of the results of these efforts is important for the application of stress reduction therapy and further improvement of surgical care.

Methods: Medline was searched from 1980 to the present using the terms "stress response," "neural-hormonal response," "fast track surgery," and "outcome in surgical patients." These papers were reviewed along with historical information relating to early descriptions of metabolic and stress responses in surgical patients.

Results: Improved understanding of the stress response in surgical patients has occurred over the past 70 years. Multiple examples of stress reduction associated with decreased morbidity and mortality are reported.

Conclusions: Reduction of stress in surgical patients has improved outcome. The use of stress reduction techniques will continue to expand and contribute to the improvement of future surgical care.

Figure 1. Sir David Cuthbertson (1900–1989), shown here with a commemorative plaque in his honor at the Glasgow Royal Infirmary, where he worked in the biochemistry department. Sir David was knighted in 1965 for his contributions to the field of animal and human nutrition.