Proactive care of Older People undergoing Surgery (POPS)

Jude Partridge is a Clinical Research Fellow and Jugdeep Dhesi is a Consultant Geriatrician and Clinical Lead at Guy’s and St Thomas’ NHS Foundation Trust. They have recently reported on a UK survey of geriatric medicine delivered services in surgery in Age and Ageing journal.

The National Confidential Enquiry into Patient Outcome and Death (NCEPOD) has published another thorough and methodologically robust report, Lower Limb Amputation: Working Together. On this occasion they examined the care of the non-traumatic amputee across the UK and concluded that “only 229/519 (44.1%) of patients were receiving a standard of care with which the advisors would be happy for themselves or their family and friends. In other words, clinical management could have been better in half of the patients included in the study”.

Unsurprisingly, the majority of cases reviewed in this report were older, multimorbid and due to the lower limb amputation, at a transition point in terms of functional status. This older, multimorbid population were inadequately prepared for surgery (only two fifths of elective patients had preassessment) and commonly required medical input from a physician postoperatively (60%). So, did NCEPOD miss an opportunity to link past reports with this current review? 

Have you heard about POPS? – Pro-active care of Older People undergoing Surgery

Jason Cross is a Clinical Nurse Specialist for the Proactive Care of Older People (POPS) team at Guys and St Thomas Hospitals and is a member of the BGS Proactive care of Older People undergoing Surgery (POPS) special interest group. He Tweets at @jdcross1970

Following the publication of the National Confidential Enquiry into Patient outcome and Death (NCEPOD) report An age old Problem 2011 and the Royal College of Surgeons (RCS) report Access all ages 2012, interest in the specialist area of perioperative medicine for the older surgical patient is gathering momentum. As a result, clinicians, commissioners and patients are recognising there is a need to have geriatrician input in surgical pathways for older people.

New recruits needed to help build services for frail older people undergoing operations

Dr Jugdeep Dhesi is Chair of the BGS Peri-operative Care of Older People Ungergoing Surgery SIG (POPS) and is consultant physician and clinical lead for the POPS service at Guy’s and St Thomas’ Hospitals.

The number of frail older people undergoing elective surgical procedures is rapidly increasing. In fact the number of older people undergoing operations, as a proportion of all those having surgery, is increasing more rapidly than is the proportion of frail older people across the population as a whole.

There are a number of reasons for this. Advances in surgical technique and improvements in anaesthetic management have made it possible to operate safely on patients who would have been considered too frail for surgery in the past. At the same time patients and doctors now expect that they will be able to receive operations much later in life.