Targeting high-risk surgical patients

NEARLY 80 per cent of UK surgical patients dying of post-operative complications come from a small group of high-risk patients – only half of whom receive “good” peri-operative care. These findings come from the latest National Confidential Enquiry into Patient Outcome and Death (NCEPOD) report – Knowing the Risk.

NCEPOD researchers found that 21 per cent of patients undergoing elective surgery had not been seen in an assessment clinic before their operation and in only 8 per cent of patients defined as ‘high risk’ was risk of death stated on the patient’s consent form. Only 22 per cent of the high-risk group were cared for in a critical care unit with the remaining 78 per cent of patients returning to the ward.

The report also found that 16 per cent of hospitals did not provide pre-admission anaesthetic clinics, 27 per cent did not have a critical care outreach team and 34 per cent did not have a policy to prevent peri-operative hypothermia.

Co-report author Dr George Findlay, NCEPOD Clinical Co-ordinator and Intensive Care Consultant, said that pre and post-operative care in the UK was in a poor state across the board: "There appears to be a serious lack of awareness of the degree of mortality risk to patients, and we have to ask if the Health Service really does appreciate the level of risk that surgical patients face? If we don’t identify the risks to patients, then how can we provide the best pre and postoperative care?!"

Among recommendations made in the report is the introduction of a UK-wide system for the rapid identification of patients who are at high risk of post-operative mortality and morbidity. All elective high-risk patients should be seen in a pre-assessment clinic and patients should be told of the mortality risks associated with surgery and this should be recorded on the consent form. Trusts should analyse the volume of work considered to be high risk and quantify the associated critical care requirements and make provision for appropriate post-operative care.