Preoperative assessment and optimisation prior to planned aortic aneurysm repair: a UK survey examining current practice and attitudes of vascular surgeons and vascular anaesthetists.
Aortic aneurysm repair
Frailty
Multidisciplinary team
Older people
POPS
Perioperative medicine
Prehabilitation
Preoperative assessment
Shared decision-making
Surgery
Journal
Perioperative medicine (London, England)
ISSN: 2047-0525
Titre abrégé: Perioper Med (Lond)
Pays: England
ID NLM: 101609072
Informations de publication
Date de publication:
13 Jun 2023
13 Jun 2023
Historique:
received:
11
01
2023
accepted:
25
04
2023
medline:
14
6
2023
pubmed:
14
6
2023
entrez:
13
6
2023
Statut:
epublish
Résumé
The majority of those diagnosed with aortic aneurysm in the UK are older, multi-morbid patients. Decision-making as to who may benefit from intervention (open or endovascular aneurysm repair) is highly variable across the NHS (as is the mode of intervention), in part because there are no detailed guidelines or consensus on preoperative assessment. Thus, there is likely to be significant variation in the pre-operative assessment and optimisation of these patients. A survey was designed to understand current practice and attitudes of vascular surgeons and vascular anaesthetists in the UK regarding preoperative assessment and optimisation of patients undergoing elective aortic aneurysm repair. The survey was reviewed and validated by an expert panel, then distributed electronically to all vascular surgical and vascular anaesthetic leads in the UK. Overall, the response rate was 68%. The responses were varied between surgeons and anaesthetists, with differences reported in the preoperative assessment and optimisation of patients, the approach to shared decision-making, and the perioperative pathway. Despite initiatives such as Getting It Right First Time (GIRFT) and National Institute for Health and Care Excellence (NICE) guidelines, variation still exists between centres with some differences in opinion observed between surgeons and anaesthetists. These differences may be leading to duplication of work in the perioperative pathway, inconsistencies in how risk is assessed and communicated with consequent variation in patient care. Addressing these issues requires awareness and implementation of existing guidelines, transdisciplinary working, efficient data-driven pathways, and structured aortic aneurysm multi-disciplinary team to promote meaningful shared decision-making.
Sections du résumé
BACKGROUND
BACKGROUND
The majority of those diagnosed with aortic aneurysm in the UK are older, multi-morbid patients. Decision-making as to who may benefit from intervention (open or endovascular aneurysm repair) is highly variable across the NHS (as is the mode of intervention), in part because there are no detailed guidelines or consensus on preoperative assessment. Thus, there is likely to be significant variation in the pre-operative assessment and optimisation of these patients.
METHODS
METHODS
A survey was designed to understand current practice and attitudes of vascular surgeons and vascular anaesthetists in the UK regarding preoperative assessment and optimisation of patients undergoing elective aortic aneurysm repair. The survey was reviewed and validated by an expert panel, then distributed electronically to all vascular surgical and vascular anaesthetic leads in the UK.
RESULTS
RESULTS
Overall, the response rate was 68%. The responses were varied between surgeons and anaesthetists, with differences reported in the preoperative assessment and optimisation of patients, the approach to shared decision-making, and the perioperative pathway.
CONCLUSIONS
CONCLUSIONS
Despite initiatives such as Getting It Right First Time (GIRFT) and National Institute for Health and Care Excellence (NICE) guidelines, variation still exists between centres with some differences in opinion observed between surgeons and anaesthetists. These differences may be leading to duplication of work in the perioperative pathway, inconsistencies in how risk is assessed and communicated with consequent variation in patient care. Addressing these issues requires awareness and implementation of existing guidelines, transdisciplinary working, efficient data-driven pathways, and structured aortic aneurysm multi-disciplinary team to promote meaningful shared decision-making.
Identifiants
pubmed: 37312201
doi: 10.1186/s13741-023-00304-4
pii: 10.1186/s13741-023-00304-4
pmc: PMC10262107
doi:
Types de publication
Journal Article
Langues
eng
Pagination
24Informations de copyright
© 2023. The Author(s).
Références
Br J Surg. 2014 Dec;101(13):1774-83
pubmed: 25388883
Crit Care. 2006;10(3):R81
pubmed: 16749940
J Vasc Surg. 2015 Feb;61(2):355-64
pubmed: 25619574
Age Ageing. 2021 Sep 11;50(5):1770-1777
pubmed: 34120179
Int J Surg. 2015 Jun;18:57-63
pubmed: 25907322
Cleve Clin J Med. 2013 Jul;80(7):423-35
pubmed: 23821685
Br J Surg. 2017 May;104(6):679-687
pubmed: 28198997
Anaesthesia. 2015 Jun;70(6):654-65
pubmed: 25959175
J Surg Educ. 2015 Jul-Aug;72(4):641-7
pubmed: 25887505
Age Ageing. 2022 Nov 2;51(11):
pubmed: 36436009
J Vasc Surg. 2014 Oct;60(4):1002-11.e3
pubmed: 25017513