Pre-operative assessment is necessary prior to the majority of elective surgical procedures, in order to ensure that the patient is fit to undergo surgery, to highlight issues that the surgical or anaesthetic team need to be aware of during the peri-operative period. These assessments also help ensure patients’ safety by avoiding complications. The decision to go for surgery advised by a clinician is of the patient.
For most procedures, barring a few minor ones, a formal pre-operative assessment consultation is a must, which generally includes a review of the patient’s case notes, a detailed medical history, clinical examination, and additional tests and investigations.
While taking a patient’s medical history even when the presumption is that the patient is healthy, one needs to identify any as-yet undetected illnesses which could have an adverse effect on the forthcoming surgery and peri-operative care. The medical history should detail the any previous surgeries patient has undergone, if he/she has any known allergies or undesirable side-effects to any medications or other agents, any known medical problems, major trauma, and current medications.
Common conditions that can affect peri-operative care include ischaemic heart disease, congestive cardiac failure, chronic respiratory disease, diabetes mellitus, and liver or renal dysfunction.
Most patients admitted for elective surgery undergo a range of routine pre-operative tests. Some of these tests are guided by the patient’s clinical needs, whilst others are done as a matter of routine. The purposes of routine pre-operative tests are to assess whether the patient may have any pre-existing health problems, to identify any medical conditions unknown to the patient, the prediction of post-operative complications.
A Preanesthetic assessment with an anaesthetist is a must.
A patient should also take note of all the precautions and medications he/she needs to take before surgery such as any routine medicine, new medicines to be taken as prescribed by the doctor, if the patient needs to observe fasting before the surgery.
In case of children and the elderly, these precautions should be followed by the parents or attendents.
Post-Operative care is the specialized care provided to a patient who has recently undergone a surgery and needs time and assistance to recover completely from the effects of the surgery.
Both elective/emergency operative procedures demands a high-quality care. Once the patient is medically stable, patient is required to move out of hospital. But, for full functional recovery, continuity of post-operative care is equally important.
So, discharge process should be smooth and discharge documents should mention all dos and don’ts including what and how to take post-op medicines, when to go for dressings and review.
Key Components of Post-Surgery Care include:
- Prevention of post-operative complications
- Wound/incision care
- Pain management
- Medical monitoring
- Early mobility
- Nutrition therapy
- Emotional wellbeing
I would rather end with a quote When a patient is happy and healthy, the surgeon smiles.
(Dr Vikas Gupta is noted general and laparoscopic surgeon. You can meet him at TaCa Centre for Surgery, Sector-6, Dwarka, New Delhi. Or call 9016-239-239)