Preoperative care – Introduction
Preoperative care begins as soon as a patient agrees to undergo an operation. It involves history taking, clinical examination, appropriate investigations, risk assessment and informed consent.
The purpose of preoperative assessment is to improve outcomes. A simple set of measures could reduce the number of complications following surgery and reduce the average length of hospital stay (Improving Surgical Outcomes Group, 2005). Good preoperative care should reduce costs, increase efficiency of operating theatres, reduce the number of patients who do not attend
for surgery or who are cancelled on the day for clinical reasons, and provide an opportunity for advising patients on their risk factors, including smoking and weight control. Good preoperative care can benefit the patient, the surgical team and the health service.
In the quest for efficient and less costly surgery, preoperative assessment has shifted increasingly from the period of time between admission and operation to the out-patient setting. Patients are often assessed by a multidisciplinary team and admitted only hours before their operation. Only for some complex major procedures, and occasionally due to individual circumstances, do patients need to be admitted a day or more before surgery in order to allow the anaesthetic and surgical team to make final preparations.
On the day of surgery, the anaesthetist and surgeon responsible for the operation must satisfy themselves from the notes and a short consultation with the patient that all appropriate steps have been taken to prepare the patient for theatre. Although much of the preoperative assessment has been delegated, the decision to proceed with the operation remains the responsibility of the surgeon and anaesthetist. The quality of preoperative assessment can directly
determine the risk of morbidity or mortality and reduce the risk that a patient will have to be cancelled on the day of surgery because appropriate investigations have not been performed. To admit a patient for an operation and find that the preoperative assessment has been inadequate is an enormous waste of resources and irritating to both the surgical team and the patient.