Optimising Pre-Surgical Care for improved patient outcomes

Dr Phil Wor­ley, Clin­i­cal Lead for the Statewide Sur­gi­cal and Peri­op­er­a­tive Care Clin­i­cal Net­work and Con­sul­tant Gen­er­al Sur­geon, pro­vides an update on a major body of work for 2022.

The Statewide Sur­gi­cal and Peri­op­er­a­tive Care Clin­i­cal Net­work has been inves­ti­gat­ing how we can best deliv­er Opti­mised Sur­gi­cal Care to all patients under­go­ing a sur­gi­cal pro­ce­dure across South Aus­tralia, includ­ing an in-depth research review.

Despite recent advances in sur­gi­cal and anaes­thet­ic tech­niques, poor­ly pre­pared patients are at increased risk for major peri­op­er­a­tive com­pli­ca­tions and longer hos­pi­tal stays. A review of research clear­ly demon­strat­ed that poor health and func­tion­al fit­ness has an impact on post-oper­a­tive out­comes and qual­i­ty of life.

If we were to look at a patient’s sur­gi­cal jour­ney, from the time that their Gen­er­al Prac­ti­tion­er (GP) refers them to a spe­cial­ist out­pa­tient clin­ic, through to them being dis­charged from the specialist’s care back to the GP, we could divide this time into four main periods:

1. The time from GP diag­no­sis, and refer­ral to the spe­cial­ist, until the patient is first seen by the spe­cial­ist (hid­den sur­gi­cal wait­ing list)
   
2. The time from when the spe­cial­ist and patient decide that a sur­gi­cal pro­ce­dure is required, up until when the patient is seen in the Pre-Admis­sion Clin­ic (Elec­tive sur­gi­cal wait­ing list — ESWL)
   
3. The time from being seen in Pre-admis­sion to being dis­charged from hos­pi­tal (Peri-oper­a­tive period)
   
4. The time from surgery to dis­charge back to the GP’s care (Post-oper­a­tive care)

In South Aus­tralia we have good ser­vices in place for min­imis­ing the ​‘peri-oper­a­tive’ risks, usu­al­ly com­menc­ing from the time a patient is seen in the pre-admis­sion clin­ic. How­ev­er, there is often only a very short time pri­or to their actu­al surgery, and this may inhib­it any chance of more sig­nif­i­cant inter­ven­tions to opti­mise the patient’s con­di­tion pri­or to their pro­ce­dure. We are left with ​‘doing the best we can’ with the patient’s cur­rent state of health.

We cur­rent­ly don’t utilise the time that patients are wait­ing to be seen by a spe­cial­ist or the time that they are on the ESWL, wait­ing for their surgery. These two time peri­ods can often add up to sev­er­al years and will usu­al­ly be a min­i­mum of 6 – 8 weeks, even for the most urgent elec­tive sur­gi­cal procedures.

When a woman receives the news that she is preg­nant, she is offered the oppor­tu­ni­ty to enrol in an ante-natal pro­gram. This con­sists of reg­u­lar vis­its with many prac­ti­tion­ers; GP and Spe­cial­ist Obste­tri­cians; mid­wives; ante-natal class­es run by allied health prac­ti­tion­ers and any oth­er spe­cialised investigations/​treatments the woman requires to opti­mise her preg­nan­cy and decrease risks.

A sim­i­lar type of ​‘pro­gram’, could be applied to a patient’s sur­gi­cal jour­ney, opti­mis­ing not only their peri and post-sur­gi­cal peri­ods but also their pre-sur­gi­cal care to decrease the risks asso­ci­at­ed with their procedure.

Opti­mised Pre-Sur­gi­cal Care (OPSC) will there­fore form a major body of work for the Statewide Sur­gi­cal and Peri­op­er­a­tive Care Net­work, aim­ing to improve patient out­comes and health care deliv­ery. The Net­works Steer­ing Com­mit­tee is cur­rent­ly eval­u­at­ing any cur­rent pro­grammes being used in this field and for­mu­lat­ing inno­v­a­tive new ways to achieve an improve­ment in deliv­ery of opti­mised pre-sur­gi­cal care.

To read about more about the Network and its projects, see Statewide Sur­gi­cal and Peri­op­er­a­tive Care Clin­i­cal Net­work.