Perioperative Assessment at the BGS Autumn Meeting

Dr Jugdeep Dhesi is Chair of the BGS Perioperative 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. She will be Chairing the POPS Session at the BGS Autumn Meeting.

Older surgical patients are presenting us geriatricians with challenges. How should geriatric medicine fit into the national agenda for perioperative medicine? Which models of care work best in improving outcomes for this complex multimorbid group of patients? Do different surgical subspecialties require different approaches? How should these services differ between the district general and teaching hospital? Should elective and emergency older surgical patients be given equivalent geriatric medicine input? How can we balance the frequent calls to involve geriatricians in the care of older surgical patients against the numerous unfilled consultant posts in ‘traditional’ geriatric medicine that already exist? These issues will be explored in the POPS SIG session at the BGS meeting in Glasgow (Friday 25th November).

Top of the POPS: the future of perioperative care

Jason Cross is an Advanced Nurse Practitioner for the Proactive Care of Older People Undergoing Surgery (POPS) team at Guy’s and St Thomas’ Hospital and is a member of the BGS POPS Special Interest Group. He Tweets at @jdcross1970

It’s been an exciting and challenging three years since I last wrote in the BGS blog, and while the messages haven’t changed much, the field of perioperative medicine continues to gather momentum.

In 2012 I wrote about the publication of An Age Old Problem (2011) and Access All Ages (2012) and how both these reports highlighted the deficiencies in surgical care for the older patient, and how geriatrician input was cited as an essential component to improving these issues.

These recommendations have been further supported by the recent publication of the new perioperative pathway vision document from the Royal College of Anaesthetists, titled Perioperative Medicine: The Pathway to Better Surgical Care. Here we note an emphasis on collaborative working with a focus on improving the outcomes and efficiency throughout the surgical pathway.

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? 

For he’s a jolly good fellow…

David Shipway is a final year registrar in geriatric medicine working at London’s Charing Cross and St Mary’s Hospitals, Imperial College NHS Trust. He is currently developing a new comprehensive surgical liaison service for patients undergoing gastrointestinal surgery.

With population ageing, the number of oldest old undergoing surgery is increasing markedly. For anyone who’s recently been the medical registrar on-call, it will come as no surprise to hear that there is considerable unmet need on the surgical wards of the UK. But the experience of pioneers in this field has proved that reactive post-operative care is not enough: a proactive approach immediately following the decision to operate is needed to improve outcomes for older patients undergoing surgery.

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.

Chance favours the prepared: surgery in older patients

David Cohen is a consultant geriatrician at Northwick Park Hospital and a spokesperson of the British Geriatrics Society.

The Duke of Edinburgh’s recent admission to hospital raised the question of surgery in older people.  Surgery and an anaesthetic are a major stress on anybody and older people are particularly susceptible.  This not only applies to people who are frail and have other illnesses but also to people who appear very fit.  Obviously, in an emergency, there may be no choice other than to go ahead with surgery but in non-urgent situations it is important to take particular precautions in later life.  Anyone contemplating surgery should make sure that they have a good general medical history and examination well before the operation.  Problems that may affect recovery should be carefully sought and investigated so that there are no surprises.