Surgery, an essential aspect of evidence-based medical care is not without risk. One in five patients will experience a post-operative complication, and post-operative mortality is the third leading cause of death worldwide.
A recent study published in the Lancet found that a patient’s post-surgical outcome was largely determined by their general fitness, comorbid state, and overall preparedness for surgery. Perioperative clinics can enhance patient care, improve surgical outcomes, and reduce perioperative complications.
Historically, preoperative assessments were conducted in silos by individual medical specialties, leading to fragmented care and oversights.
The need for a more unified and patient-centred approach prompted the evolution of perioperative clinics, which provide a structured and multidisciplinary approach to patient care before, during, and after elective surgery. These clinics improve patient outcomes through:
- Providing detailed risk assessments with subsequent shared decision-making on the suitability of various treatment options
- Management and optimisation of comorbidities – diabetes, heart disease, COPD and OSA, renal impairment and anaemia
- Full frailty and functional capacity assessments with physiotherapy and OT-led prehabilitation and rehabilitation sessions
- Lifestyle advice and modification – nutrition and diet, smoking cessation, alcohol minimisation weight loss advice
- Cognitive, mental, and psychological assessments with full backup psychological support
- Ongoing patient and family education and involvement in the recovery process
- Continuing management and support into the post discharge period.
The key paradigm shift in perioperative care is recognising the importance of multidisciplinary input. Surgeons, anaesthetists, nurses, allied health clinicians and other specialists collaborate to provide holistic preoperative assessments.
Public hospitals and national health services have been at the forefront in establishing multidisciplinary perioperative services. Patients at high risk of post-surgical complications undergo elective surgery in private hospitals too. Thus consultant led multidisciplinary perioperative clinics are needed for private patients.
Benefits of perioperative clinics
Improved patient outcomes: Perioperative care ensures that patients are optimally prepared for surgery, reducing the risk of complications and promoting faster recovery.
Cost savings: By addressing potential health issues before surgery, perioperative care can minimise postoperative complications, hospital length of stay, hospital readmissions, and associated healthcare costs. Investing in perioperative care contributes to the efficient use of healthcare resources by streamlining preoperative assessments and ensuring appropriate resource allocation.
Enhanced patient experience: By providing a positive and supportive experience for patients, offering education, counselling, and coordination of care to ease the anxiety associated with surgery.
Collaborative care: A multidisciplinary approach, collaborating with primary care, surgeons, anaesthetists, and other healthcare professionals to deliver comprehensive and coordinated care.
Barriers and overcoming them
Private healthcare settings often operate under tight financial constraints, and the initial investment required for establishing perioperative clinics can be perceived as a barrier. The costs associated with staffing, technology, and infrastructure may deter institutions from embracing this model of care.
Coordinating various healthcare professionals involved in perioperative care can be challenging, especially in private settings where the structure may be less hierarchical than larger institutions. Establishing a seamless workflow and effective communication pathways is essential for the success of perioperative clinics.
Change management can be a significant hurdle in private healthcare settings where established practices may resist disruption. Physicians, surgeons, and other stakeholders may be sceptical about the benefits of perioperative clinics or perceive them as additional bureaucratic layers.
To address financial concerns, an emphasis on the long-term cost-effectiveness of perioperative clinics should be conveyed. Research has consistently shown that proactive management of preoperative risk factors leads to reduced complications, shorter hospital stays, and overall cost savings. Providing evidence of the financial benefits can help garner support from administrators and stakeholders.
Private healthcare settings can explore collaborative models for resource sharing. Pooling resources with neighbouring institutions or forming alliances with outpatient facilities can help distribute the financial burden and enhance the viability of perioperative clinics. Shared electronic health record systems and standardised protocols can facilitate seamless collaboration.
Addressing logistical challenges requires a focus on streamlined workflows and technology integration. Implementing electronic health records that enable seamless information exchange among healthcare professionals can enhance communication and coordination. Automated scheduling systems can optimise clinic workflows, ensuring efficient use of resources.
Resistance to change can be mitigated through comprehensive education and engagement initiatives targeting key stakeholders. Workshops, seminars, and peer-led discussions can address concerns, clarify misconceptions, and highlight the benefits of perioperative clinics. Involving key stakeholders in the planning and decision-making processes fosters a sense of ownership and commitment.
Recognising the diversity among private healthcare settings, medical professionals should develop tailored implementation strategies. Consideration of the specific needs, size, and structure of each institution is crucial. Flexible models adaptable to different practice environments enhance the likelihood of successful adoption.
Perioperative clinics have evolved into indispensable components of modern surgical care, embodying a patient-centric and collaborative approach. Through comprehensive preoperative assessments, risk stratification, and multidisciplinary collaboration, they play a vital role in optimising patient outcomes and minimising perioperative complications.
The integration of perioperative clinics into standard private practice will likely become more widespread, further emphasising the importance of a patient-centred holistic approach to the entire perioperative continuum. Future surgical care undoubtedly includes an ongoing commitment to refining and expanding the role of perioperative clinics to meet the evolving needs of patients and the healthcare system.
Key messages
- One in five surgical patients experience a post operative complication
- Improving surgical outcomes requires a multidisciplinary approach
- Perioperative services are part of the solution.
– References available on request
Author competing interests – nil