Chapter 24 Postoperative Care including Perioperative Optimisation

Perioperative care is integrated care delivered to the patient by a multidisciplinary team before, during and after surgery. Postoperative pain can delay the patient’s recovery, increase the risk of chest complications and chronic pain and contribute to a poor patient experience. Prehabilitation is a process of improving the functional capacity of patients prior to major surgery in order to improve postoperative outcomes. The time period between the decision to operate and the surgery date itself is used for prehabilitation. Postoperative complications are an important cause of morbidity, mortality, extended hospital stay and increased costs. Early detection of respiratory complications is facilitated by periodic assessment of airway patency, respiratory rate and routine oxygen saturation measurement, performed during emergence and recovery. Upper airway obstruction is one of the commonest immediate postoperative complications and can be due to laryngospasm, persisting relaxation of airway muscles, soft-tissue oedema, haematoma, vocal cord dysfunction or a foreign body.

Multiple Choice Questions
Weblinks

Journal articles

https://www.bjanaesthesia.org/article/S0007-0912(17)30985-6/fulltext/ (free)

Acute kidney injury in the perioperative period is a source of major morbidity and mortality. Various patient- and non-patient-related factors contribute to it. Several definitions of acute kidney injury have been proposed that use changes in serum creatinine and urine output to stage kidney injury.

https://www.bjanaesthesia.org/article/S0007-0912(17)30201-5/fulltext/ (free)

Pulmonary complications are major sources of morbidity after surgery. Every effort should be made to modify risk factors prior to surgery.

https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/anae.14138/ (free)

Perioperative cardiac complications can be a major source of adverse outcome after surgery. It is important to identify and modify these risk factors. High-risk patients should be appropriately monitored and managed in advanced centres staffed by per-operative physicians.

https://www.acpjournals.org/doi/full/10.7326/0003-4819-144-8-200604180-00009/ (free)

Proper identification of preoperative pulmonary risk factors by clinical and laboratory testing is essential to prevent postoperative pulmonary complications.

Guidelines and policies

https://anaesthetists.org/Portals/0/PDFs/Guidelines%20PDFs/Guideline_immediate_post_anaesthesia_recovery_2013_final.pdf?ver=2018-07-11-163754-287&ver=2018-07-11-163754-287/ (free)

Patients are transferred to a postanaesthesia care unit (PACU) after surgery to recover from anaesthesia. They are monitored for immediate postsurgery and anaesthesia complications prior to their transfer to the ward. This document sets out standards and recommendations that PACU should comply with.

https://www.england.nhs.uk/ourwork/clinical-policy/sepsis/nationalearlywarningscore/ (free)

NEWS (National Early warning Score) is a tool developed by the Royal College of Physicians for early detection of clinical deterioration in adult patients. Depending on the score, an appropriate clinical response is initiated. An updated version NEWS 2 was published in 2017.

https://ics.ac.uk/Society/Policy_and_Communications/Patients_and_Relatives/Levels_of_Care/Society/Patients_and_Relatives/Levels_of_Care.aspx?hkey=2a40dba7-a0b8-4669-ac85-cfa224275ca3/ (free)

Patients on intensive care units have different needs for organ support. This document produced by the Intensive Care Society classifies patients according to the level of support needed.

https://www.transfusionguidelines.org/transfusion-handbook/7-effective-transfusion-in-surgery-and-critical-care/7-1-transfusion-in-surgery.pdf (free)

These guidelines suggest strategies to manage perioperative anaemia, which can increase morbidity and mortality. Blood transfusion is associated with risks. These risks can be minimised by preoperative treatment of anaemia, minimising blood loss during surgery, monitoring coagulation and appropriate use of blood transfusion.

https://www.nice.org.uk/guidance/ng148/ (free)

This guideline aim to improve early recognition and treatment of acute kidney injury and reduce the risk of complications.

https://www.nice.org.uk/guidance/ng158/ (free)

Prevention, rapid diagnosis and treatment of deep vein thrombosis (DVT) or pulmonary embolism (PE) in the perioperative period is essential. This guideline provides scoring systems to aid that and also describes additional diagnostic tests.

Website

https://cpoc.org.uk/guidelines-and-resources/

Provides a wealth of guidelines, resources and case studies on perioperative care. The Centre for Perioperative Care (CPOC) aims to integrate care provided by various healthcare providers during the perioperative period in order to improve patient outcomes and also use the opportunity given by the perioperative episode to improve the patient’s general health.

  Back To TopTo top