Goals of assessment clinic
Overarching philosophy
Effective Pre-Operative Assessment facilitates surgery with no or minimal delay, and addresses issues that could lead to the cancellation of a procedure, or patient harm if not adequately attended to. The Pre-Operative Assessment is tailored to uncover these ‘red flag’ issues, and provide evidence-based guidance.
Elements of effective assessment
Several areas are important in effective Pre-Operative Assessment.
- Establish an accurate measure of the patients current baseline.
- Ensure key pre-existing conditions are managed with adequate continuity while an inpatient, including that key medications are correctly administered or stopped before the surgical procedure.
- Ensure that we adequately investigate and manage issues that could lead to complications and/or patient harm.
- Ensure that any abnormal findings and results are communicated effectively to the patients GP, the consultant surgeon, or any relevant allied health professionals that might need to contribute to the patient’s care.
High yield issues to identify
Key ‘red flag’ issues that Pre-Operative Assessment seeks to identify or address are outlined below:
Cardiovascular
- Severe heart failure
- Ischaemic heart disease
- Arrhythmias
- Severe valvular disease
- Hypertension (poorly controlled)
- Poor functional status and frailty (DASI/frailty score)
Respiratory
- Severe pulmonary hypertension
- Obstructive Sleep Apnoea (OSA)
- Severe COPD/asthma
Neurologic
- Chronic pain
- Parkinson’s disease
- Epilepsy
Endocrine
- Diabetes (especially if poorly controlled)
- Adrenal insufficiency
Gastrointestinal
- Advanced liver disease
Haematological
- Severe thromboembolic disease
- Bleeding disorders
- Severe anaemia
Immunological
- True allergy to medications/latex,etc
Renal
- Severe Chronic Kidney Disease
Medications
- Anti-platelets
- Anti-coagulants
- Anti-hypoglycaemics
- Insulins
- Steroids
- Anti-epileptics
- Anti-Parkinsonian
- Chronic pain medications
- Biologics