Author:
Scarfield Phoebe,Ryan Jack,Sallam Morad,Saratzis Athanasios,Pichel Adam C.,Dhesi Jugdeep K.,Partridge Judith S. L.
Abstract
Abstract
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
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
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
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.
Publisher
Springer Science and Business Media LLC
Reference26 articles.
1. American College of Surgeons. ACS NSQIP surgical risk calculator. 2022. Available from: https://riskcalculator.facs.org/RiskCalculator/PatientInfo.jsp. [Cited 2022 Aug 29].
2. Carlisle JB, Danjoux G, Kerr K, Snowden C, Swart M. Validation of long-term survival prediction for scheduled abdominal aortic aneurysm repair with an independent calculator using only pre-operative variables. Anaesthesia. 2015;70(6):654–65.
3. Centre for Perioperative Care. Guideline for Perioperative Care for People Living with Frailty Undergoing Elective and Emergency Surgery. 2021. Available from: https://cpoc.org.uk/guidelines-resources-guidelines/perioperative-care-people-living-frailty. [Cited 2022 Jun 21].
4. Colbert CY, Diaz-Guzman E, Myers JD, Arroliga AC. How to interpret surveys in medical research: a practical approach. Cleve Clin J Med. 2013;80(7):423–35.
5. GIRFT. Anaesthesia and perioperative medicine – getting it right first time. Available from: https://www.gettingitrightfirsttime.co.uk/medical-specialties/anaesthesia-perioperative-medicine/. [Cited 2022 Jun 21]