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This report, by the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) looks at the peri-operative mortality rate in the UK and argues that people die because we do not give them the level of care they are entitled to expect. In this report less than half of the high-risk patients received care that the expert advisors thought they would accept from themselves or their own institutions. Th reasons for this are examined within the report.

Postoperative delirium is common and has multiple adverse consequences. Guidelines recommend routine screening for postoperative delirium beginning in the post-anaesthesia care unit. The 4 A’s test (4AT) is a widely used assessment tool for delirium; however, there are no studies evaluating its use in the post-anaesthesia care unit.  Saller et al. evaluated the performance of the 4AT in the post-anaesthesia care unit in a tertiary German medical centre. The findings published in Anaesthesia suggest that the 4AT is an effective and robust instrument for delirium detection in the post-anaesthesia care unit. suggest that the 4AT is an effective and robust instrument for delirium detection in the post-anaesthesia care unit.

This leaflet produced by the World Health Organization (WHO) is aimed at patients who are undergoing a surgical procedure. It aims to enable communication between you and your surgical team, including you in safety checks.

If you or your child is undergoing a surgical procedure, be sure to communicate the following to your healthcare provider. Your active participation in health care is important for your safety. This information from the World Health Organization (WHO) will help your discussion with your care-provider. Be a well-informed partner in your own care. Before surgery 1. Tell them about your previous surgeries, anesthesia and current medications, including herbal remedies. 2. Tell them if you are pregnant or breast-feeding. 3. Tell them about your health conditions (allergies, diabetes, breathing problems, high blood pressure, anxiety, etc.). 4. Ask about the expected length of your hospital stay. 5. Ask for personal hygiene instructions. 6. Ask them how your pain will be treated. 7. Ask about fluid or food restrictions. 8. Ask what you should avoid doing before surgery. 9. Make sure that the correct site of your surgery is clearly marked on your body. After surgery 1. Tell them about any bleeding, difficulty breathing, pain, fever, dizziness, vomiting or unexpected reactions. 2. Ask them how you can minimise infections. 3. Ask them when you can eat food and drink fluids. 4. Ask when you can resume normal activity (e.g. walking, bathing, lifting heavy objects, driving, sexual activity, etc.). 5. Ask what, if anything, you should avoid doing after surgery. 6. Ask about the removal of stitches and plasters. 7. Ask about any potential side effects of prescribed medications. 8. Ask when you should come back for a check-up.

Maintaining safe elective surgical activity during the global coronavirus disease 2019 (COVID‐19) pandemic is challenging and it is not clear how COVID‐19 may impact peri‐operative morbidity and mortality in this population. Therefore, adaptations to normal care pathways are required. Here, Kane et al. establish if implementation of a bespoke peri‐operative care bundle for urgent elective surgery during a pandemic surge period can deliver a low COVID‐19‐associated complication profile. Kane et al. present a single‐centre retrospective cohort study from a tertiary care hospital of patients planned for urgent elective surgery during the initial COVID‐19 surge in the UK between 29 March and 12 June 2020.

This project aims to develop peer consensus centred on specific themes defined by the steering group covering topics relevant to the optimal, universal and evidence-based care bundle to reduce surgical site infections (SSIs). It will support building expert consensus around best practices when selecting the care bundle to reduce surgical site infections in practice. It is hoped that the output will support best practice patient management in Europe. The survey takes under 10 minutes to complete. Please review each statement and indicate your level of agreement with it (tick one box only per statement). Please only complete this questionnaire once. Your anonymous responses will be a source of data for the development of a consensus publication. This project has been initiated and funded by Becton Dickinson and is being managed and delivered by Triducive.

In the fast-evolving realm of contemporary healthcare, surgical techniques have attained unprecedented levels of advancement, leading to substantial enhancements in patient care. However, the journey towards complete recovery extends far beyond the operating room, emphasising the importance of effective postoperative care. In this critical phase, patient partnerships play a pivotal role, ensuring a holistic and personalised approach to recovery.

Mesh implantation for hernia repair has become standard practice for the majority of hernia repairs. Mesh-based hernia repairs have been shown to be a durable solution, however, postoperative complications, such as chronic postoperative pain, remain a concern. To date, there have been few investigations into the inflammatory response to mesh. In this study, Fadaee et al. present their experience in diagnosing and treating a subpopulation of patients who require mesh removal due to a possible mesh implant illness. They found predisposing factors include female sex, history of autoimmune disorder, and multiple medical and environmental allergies and sensitivities. Presenting symptoms included spontaneous rashes, erythema and oedema over the area of implant, arthralgia, headaches and chronic fatigue. Long-term follow up after mesh removal confirmed resolution of symptoms after mesh removal. The authors hope this provides greater attention to patients who present with vague, non-specific but debilitating symptoms after mesh implantation.

Anaemia is associated with adverse outcomes of surgery. The blood loss of surgery or trauma can cause or worsen anaemia. People who have anaemia have a worse result from their operation including poorer wound healing, slower mobilisation and an increased risk of death. The Centre for Perioperative Care (CPOC) perioperative anaemia guideline has been developed using a whole pathway approach. It contains recommendations for patients of all ages undergoing surgery and for healthcare professionals in both emergency and elective surgical settings and across specialties. The aim of this guideline is to ensure that the patient is at the centre of the whole process, and that everyone involved in their care carries out their individual responsibilities to minimise the risk from anaemia.  To make the best of this approach we need to make sure patients and all health care professionals including GPs and multidisciplinary hospital teams work together to: Identify anaemia early in the pathway. Make the patient aware of this and all actions going forward. Find the cause of the anaemia. Use tried and tested treatments for anaemia before surgery. This could include advice on changes in diet, oral treatments such as iron supplements and the use intravenous iron when necessary. Make sure the patient has a personalised treatment programme including providing appropriate information about the pros and cons of the different approaches suggested to the patient and how long these should be continued. Communicate clearly between different members of the team so that operations are not cancelled unnecessarily and improve the interface between primary care and hospitals. Talk openly to the patient about the benefits and risks of managing anaemia and the surgery.

In order to prevent hypothermia during or after surgery, patients can be warmed before or during the induction of anaesthesia. If the patient is warmed before, this is known as prewarming, and if they are warmed at the same time that anaesthetics are given, this is known as cowarming. This study in the Journal of Anaesthesiology and Clinical Pharmacology aimed to investigate whether cowarming is as good as prewarming in preventing the occurrence of intraoperative hypothermia.

Hypothermia is a common problem in the operating theatre, and it contributes to many poor outcomes including rising costs, increased complications and higher morbidity rates. This literature review in the Journal of PeriAnesthesia Nursing aimed to determine the best method and time to prewarm a patient in order to prevent hypothermia during or after surgery. The authors suggest that forced-air warming is most effective in preventing perioperative hypothermia. Eighty-one percent of the experimental studies reviewed found that there was a significantly higher temperature throughout surgery and in the post-operative care unit for patients who received forced-air prewarming.

This guideline covers preventing and managing inadvertent hypothermia in people aged 18 and over having surgery. It offers advice on assessing patients’ risk of hypothermia, measuring and monitoring temperature, and devices for keeping patients warm before, during and after surgery. This guideline includes recommendations on: information for patients measuring temperature warming patients before their operation, including transfer to the operating theatre keeping patients warm during their operation, including ambient temperature in the operating theatre and temperature of intravenous fluids keeping patients warm after their operation

The purpose of this investigation by the Healthcare Safety Investigation Branch (HSIB) is to help improve patient safety in relation to the care of patients who have NHS-funded surgery in an independent hospital. This was initiated in the context of the COVID-19 pandemic, where because of increased pressure on the NHS, independent hospitals have been providing more care for NHS patients, including urgent elective surgical care and delivery of cancer pathways. The HSIB investigation reviewed the experience of a patient with a diagnosis of bowel cancer, who was booked to undergo laparoscopic (keyhole) surgery to remove part of his bowel in in an independent hospital. Following surgery, the patient made slow progress and on day eight following surgery he started to deteriorate rapidly. He was transferred to the local NHS hospital for investigation and further surgery. He died later the same day as a result of sepsis following a complication of his recent surgery. The investigation explored: Safety issues associated with the establishment of surgical services in independent hospitals to support the NHS and in particular the specialist services that are in place to deliver patient care. The assessment of patients prior to surgery to identify their risk and suitability for an operation and where it was to be undertaken; this included identification of patients with frail physical states. Key findings included: National and local NHS organisations had limited understanding of independent hospitals’ capabilities. This resulted in variation in how independent hospitals were used during Covid-19. Some independent hospitals saw patients with increasingly complex conditions and undertook more complex operations during Covid-19. The increasing complexity was well managed where capability of the independent hospitals had been evaluated and addressed prior to implementation of new services. Where pathways between NHS and independent hospitals were effective, it was often found that relationships between the hospitals had been longstanding and direct. There was variation in how preoperative assessments were undertaken across NHS and independent hospitals. This included what tests were ordered and risk assessments undertaken. Preoperative nutrition screening was inconsistent across NHS and independent hospitals. Examples were identified where it was not undertaken, or undertaken too late to allow any preoperative optimisation – that is, to make sure the patient was in the best possible nutritional state before their operation. Remote preoperative assessment became the norm during Covid-19, but created risks when staff were not able to see the patient. Lack of video call facilities and staff preference meant assessments were commonly done by telephone. Safety recommendations HSIB recommends that NHS England and NHS Improvement ensures that effective processes have been implemented in integrated care systems to identify local capability and capacity of their independent acute hospitals. HSIB recommends that NHSX expands its work programme addressing the challenges associated with interoperability of information systems used in healthcare to include transfer of information between the NHS and independent sector in support of safe care delivery. HSIB recommends that the Care Quality Commission reviews and appropriately develops its methodology for regulatory assurance of arrangements between NHS and independent providers for the provision of care across care pathways. This is to include any screening and risk management processes used to ensure the safe transfer of care between providers. HSIB recommends that NHS England and NHS Improvement reviews models of perioperative care for their value and impact. This should inform future work to support implementation of a standardised approach, based on evidence, across all healthcare providers that deliver surgical services. HSIB recommends that NHS England and NHS Improvement establishes a process to ensure that findings of the National Institute for Health Research’s policy research programme into frailty in younger patient groups are reviewed and acted upon.

Frailty is a condition characterised by loss of biological reserve, failure of physiological mechanisms and vulnerability to a range of adverse outcomes including increased risk of morbidity, mortality and loss of independence in the perioperative period. With the increasing recognition of the prevalence of frailty in the surgical population and the impact on postoperative outcomes, The Centre for Perioperative Care (CPOC) and the British Geriatrics Society (BGS) have worked together to develop a whole pathway guideline on perioperative care for people living with frailty undergoing elective and emergency surgery. The scope of this guideline covers all aspects of perioperative care relevant to adults living with frailty undergoing elective and emergency surgery. It is written for healthcare professionals involved in delivering care throughout the pathway, as well as for patients and their carers, managers and commissioners. Download frailty pathway infographic Download the guidelines

The CPOC Newsletter is for all doctors, nurses and allied health professionals working in or with an interest in the developments of perioperative care. The monthly publication highlights the most up to date information on the workstreams, partner projects, perioperative events, recently published journals, live surveys and successful perioperative initiatives.

The Royal College of Surgeons of Edinburgh (RCSEd) has partnered with the anti-smoking charity ASH (Action on Smoking and Health) to support surgeons in encouraging patients to improve their survival chances by quitting smoking ahead of surgery. Fewer postoperative complications, shorter hospital stays and better long-term outcomes are some of the evidence-based benefits the College’s members are being asked to highlight to patients. The campaign urges all surgeons to view patient consultations as ‘teachable moments’, during which patients may be more receptive to intervention and more motivated to quit. As part of the discussion of risks associated with a procedure, surgeons should outline the reduction in risk associated with smoking cessation, with the recommendation to stop at least two months before the operation.