The Case for Perioperative Care

Around 10 million patients undergo surgery each year in the NHS

Any healthcare pathway catering for a population of this size must be simple, safe and efficient. However, problems arise when we identify individual patients on this pathway who have complex medical needs. This simple care pathway can then feel inflexible, as we attempt to address different medical problems for each patient we see.

Fortunately, the great majority of patients are well served by existing NHS surgery pathways. However, there is a growing body of evidence that the needs of the high-risk surgical patient are not being met. As a result, patients who are older or have significant medical problems are offered major surgery in a system that cannot adapt to minimise their risk of complications.

Around 250,000 high-risk patients undergo surgery each year in the NHS. This is approximately 15% of all those who need surgery as a hospital inpatient. We believe these patients need extra care to ensure they have the best possible recovery after surgery, but any solution to this problem must function well within the existing high volume NHS surgical service.

Traditionally, the care of patients undergoing major surgery has been tailored to the operation itself and the index disease being treated by the procedure. However, the majority of complications, which occur after surgery are not due to technical errors or failures by the surgical team, but are medical complications such as pneumonia or myocardial infarction. The prevention and treatment of these medical complications requires a broader approach than we currently take to the care of the surgical patient.

Unmet need

The scale of this unmet need is becoming increasingly clear, and with 10 million patients undergoing surgery each year in the NHS, even a low rate of avoidable harm will be associated with many preventable complications and deaths. The long-term impact of this short-term postoperative harm is also increasing.

Some surgical specialties have already made good progress in improving the quality of perioperative care. Cardiac surgery provides an excellent example of an efficient patient-centred care pathway led by a multi-disciplinary team, achieving better outcomes than many other types of major surgery. We need to take a similar approach for patients undergoing all forms of surgery. To achieve this, we need to define an integrated agenda for healthcare policy around the challenge of providing healthcare to patients undergoing major surgery.

We believe that perioperative care provides a solution to the unmet need, using existing skills and expertise within the NHS to reduce variation and improve patient outcomes after surgery.