Hospitals could reduce length of stay and improve patient outcomes if they reimagine the way more than 10 million patients a year undergo surgery in the NHS, HSJ has been told.

  • Royal college says new surgery pathway could help 250,000 patients a year
  • Clinicians urged to consider wider health factors that can affect long term recovery
  • President says how the current medical workforce was trained was not “fit for purpose”

The Royal College of Anaesthetists has urged NHS leaders to develop what it calls a perioperative medicine approach to surgery, where clinicians consider not just the surgery but wider health factors that can affect a patient’s long term recovery.

Surgery theatre

More than 10 million patients a year undergo surgery in the NHS, costing £16bn

The college said a better integrated approach to surgical patients would help the 250,000 patients a year who are at risk of developing complications from deteriorating after surgery. It would also benefit hospitals as fewer readmissions and complications would lead to fewer cancelled operations, as well as quicker recovery and discharge from hospital.

More than 10 million patients a year undergo surgery in the NHS at an annual cost of £16bn. An ageing population with more long term conditions and comorbidities means there is a growing risk of a higher rate of complications and death, the college said.

Under its proposal, the RCOA said a perioperative medicine department or perioperative consultant would take the lead on a patient’s pathway and would consider wider medical disease and the needs of the patient beyond the immediate reason for surgery.

The teams would coordinate care from referral to the decision to offer surgery and, in the weeks and months after the procedure, provide a single point of access for GPs, community teams and surgeons.

J-P van Besouw, president of the college, told HSJ the way the current medical workforce was trained was not “fit for purpose”. He said all doctors were trained “to be very good at very narrow aspects of what they do. We have very good bricks but the mortar that holds the wall together is weak so when you kick the wall it falls over.”

He said a more integrated approach towards a patient’s progression through their surgical pathway would lead to improvements and was essential given demographic changes.

“We have an ageing population with multiple comorbidities and that presents a much higher risk to surgery than was the case historically,” he added.

“The more complications you have and the longer you have them, the greater the ultimate cost to the health system is. If we treat things early and appropriately then patients have a better quality of life, they get out of hospital quicker and the long term cost to the service is substantially less.”

Source: The Royal College of Anaesthetists

Some hospitals that have already adopted perioperative methods have reported improvements. Sheffield Teaching Hospitals Foundation Trust’s obstetrics unit has implemented an enhanced recovery scheme for Caesarean section patients, resulting in a rise in discharge on the first day after the operation from 1.6 per cent to 25 per cent. The trust estimated this saved £90,000 and freed up beds.

Newcastle General Hospital, run by Newcastle upon Tyne Hospitals FT, developed a multidisciplinary pre-operation assessment 10 years ago resulting in surgery cancellations due to a person’s fitness falling from 10 per cent to under 1 per cent.

Monty Mythen, chair of the perioperative medicine programme at RCOA, said: “Surgical pathways can be improved and there are examples of it being done extremely well already but it is the variability that we are trying to change.

“About 80 per cent of hospitals have pre-surgical assessment but a fully mature and embedded perioperative team is unusual. There is no reason why we cannot make perioperative medicine a reality for every NHS patient who needs a little extra care to ensure surgery is a safe and effective treatment for them.”