Preoperative assessment and optimisation prior to planned aortic aneurysm repair: a UK survey examining current practice and attitudes of vascular surgeons and vascular anaesthetists
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 ther...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-06-01
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| Series: | Perioperative Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13741-023-00304-4 |
| _version_ | 1797801306268631040 |
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| author | Phoebe Scarfield Jack Ryan Morad Sallam Athanasios Saratzis Adam C. Pichel Jugdeep K. Dhesi Judith S. L. Partridge |
| author_facet | Phoebe Scarfield Jack Ryan Morad Sallam Athanasios Saratzis Adam C. Pichel Jugdeep K. Dhesi Judith S. L. Partridge |
| author_sort | Phoebe Scarfield |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-13T04:48:26Z |
| format | Article |
| id | doaj.art-6879b9a3445a4e039f550762bbf085e2 |
| institution | Directory Open Access Journal |
| issn | 2047-0525 |
| language | English |
| last_indexed | 2024-03-13T04:48:26Z |
| publishDate | 2023-06-01 |
| publisher | BMC |
| record_format | Article |
| series | Perioperative Medicine |
| spelling | doaj.art-6879b9a3445a4e039f550762bbf085e22023-06-18T11:20:48ZengBMCPerioperative Medicine2047-05252023-06-011211810.1186/s13741-023-00304-4Preoperative assessment and optimisation prior to planned aortic aneurysm repair: a UK survey examining current practice and attitudes of vascular surgeons and vascular anaesthetistsPhoebe Scarfield0Jack Ryan1Morad Sallam2Athanasios Saratzis3Adam C. Pichel4Jugdeep K. Dhesi5Judith S. L. Partridge6Guy’s and St. Thomas’ NHS Foundation TrustGuy’s and St. Thomas’ NHS Foundation TrustGuy’s and St. Thomas’ NHS Foundation TrustNIHR Leicester Biomedical Research Centre GBManchester Royal InfirmaryGuy’s and St. Thomas’ NHS Foundation TrustGuy’s and St. Thomas’ NHS Foundation TrustAbstract 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.https://doi.org/10.1186/s13741-023-00304-4Multidisciplinary teamPreoperative assessmentPerioperative medicineAortic aneurysm repairFrailtyShared decision-making |
| spellingShingle | Phoebe Scarfield Jack Ryan Morad Sallam Athanasios Saratzis Adam C. Pichel Jugdeep K. Dhesi Judith S. L. Partridge Preoperative assessment and optimisation prior to planned aortic aneurysm repair: a UK survey examining current practice and attitudes of vascular surgeons and vascular anaesthetists Perioperative Medicine Multidisciplinary team Preoperative assessment Perioperative medicine Aortic aneurysm repair Frailty Shared decision-making |
| title | Preoperative assessment and optimisation prior to planned aortic aneurysm repair: a UK survey examining current practice and attitudes of vascular surgeons and vascular anaesthetists |
| title_full | Preoperative assessment and optimisation prior to planned aortic aneurysm repair: a UK survey examining current practice and attitudes of vascular surgeons and vascular anaesthetists |
| title_fullStr | Preoperative assessment and optimisation prior to planned aortic aneurysm repair: a UK survey examining current practice and attitudes of vascular surgeons and vascular anaesthetists |
| title_full_unstemmed | Preoperative assessment and optimisation prior to planned aortic aneurysm repair: a UK survey examining current practice and attitudes of vascular surgeons and vascular anaesthetists |
| title_short | Preoperative assessment and optimisation prior to planned aortic aneurysm repair: a UK survey examining current practice and attitudes of vascular surgeons and vascular anaesthetists |
| title_sort | preoperative assessment and optimisation prior to planned aortic aneurysm repair a uk survey examining current practice and attitudes of vascular surgeons and vascular anaesthetists |
| topic | Multidisciplinary team Preoperative assessment Perioperative medicine Aortic aneurysm repair Frailty Shared decision-making |
| url | https://doi.org/10.1186/s13741-023-00304-4 |
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