A survey of UK peri‐operative medicine: pre‐operative care

Abstract

SummaryThe majority of UK hospitals now have a Local Lead for Peri-operative Medicine (n = 115). They were asked to take part in an online survey to identify provision and practice of pre-operative assessment and optimisation in the UK. We received 86 completed questionnaires (response rate 75%). Our results demonstrate strengths in provision of shared decision-making clinics. Fifty-seven (65%, 95%CI 55.8-75.4%) had clinics for high-risk surgical patients. However, 80 (93%, 70.2-87.2%) expressed a desire for support and training in shared decision-making. We asked about management of pre-operative anaemia, and identified that 69 (80%, 71.5-88.1%) had a screening process for anaemia, with 72% and 68% having access to oral and intravenous iron therapy, respectively. A need for perioperative support in managing frailty and cognitive impairment was identified, as few (24%, 6.5-34.5%) respondents indicated that they had access to specific interventions. Respondents were asked to rank their 'top five' priority topics in Peri-operative Medicine from a list of 22. These were: shared decision-making; peri-operative team development; frailty screening and its management; postoperative morbidity prediction; and primary care collaboration. We found variation in practice across the UK, and propose to further explore this variation by examining barriers and facilitators to improvement, and highlighting examples of good practice.

Clinical guideline and recommendations on pre‐operative exercise training in patients awaiting major non‐cardiac surgery

“…Reduced quality of life and independence, increased rates of readmission, reduced longer term survival and an increased health economic burden may all follow. Healthcare professionals working across peri-operative medicine should develop strategies to address this problem [18][19][20].…”

Pre‐operative variables and complications after oesophagectomy – a reply

“…Hartford-Beynon and Allan sensibly suggest the possible use of ultrasound screen prompts in 'Stop before you block' (SBYB) protocols [1,2]. We hope that manufacturers of ultrasound machines will take this seriously and consider the simple redesign of their software to incorporate this SBYB screensaver as a default.…”

“…Cardiopulmonary exercise testing (CPET) is increasingly available in centres throughout the UK, with 60% of clinics using CPET for high-risk surgical patients within their pre-operative assessment service [2]. When we introduced CPET to the oesophagogastric group, we designed a pathway that included early involvement of the peri-operative anaesthetic consultant in the pre-operative assessment clinic before discussion of individuals at the oesophagogastric MDT meeting.…”

“…We have found that holistic assessment of patients early in their cancer pathway has become a valued aspect of their treatment, particularly for those presenting with the highest perioperative risks. Frozen ultrasound image as a prompt for stop before you block Hartford-Beynon and Allan sensibly suggest the possible use of ultrasound screen prompts in 'Stop before you block' (SBYB) protocols [1,2]. We hope that manufacturers of ultrasound machines will take this seriously and consider the simple redesign of their software to incorporate this SBYB screensaver as a default.…”

Social prescribing and pre‐operative care

“…Bougeard et al. identified that many hospitals are currently screening high‐risk surgical patients to assess potential benefits from pre‐operative lifestyle interventions, in particular, weight control, increased physical activity and reduced alcohol intake . However, only 23% of survey respondents had access to some kind of interventional weight management pathway, 28% for physical inactivity, and 30% for reducing alcohol intake .…”