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      The emerging specialty of perioperative medicine: a UK survey of the attitudes and behaviours of anaesthetists

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          Abstract

          Background

          In 2014, the Royal College of Anaesthetists (RCoA) launched the Perioperative Medicine Programme to facilitate the delivery of best preoperative, intraoperative and postoperative care through implementation of evidence-based medicine to reduce variation and improve postoperative outcomes. However, variation exists in the establishment of perioperative medicine services in the UK. This survey explored attitudes and behaviours of anaesthetists towards perioperative medicine, described current anaesthetic-led perioperative medicine services across the UK and explored barriers to anaesthetic involvement in perioperative medicine.

          Methods

          Survey content based on the RCoA vision document was refined and validated using an expert panel. An anonymous electronic survey was then sent by email to the members of the RCoA.

          Results

          Seven hundred fifty-eight UK anaesthetists (4.5% of the RCoA mailing list) responded to the survey. Of these, 64% considered themselves a perioperative doctor, with 65% having changed local services in response to the RCoA vision. Barriers to developing perioperative medicine included insufficient time (75%) and inadequate training (51%). Three quarters of respondents advocate anaesthetists leading the development of perioperative medicine.

          Conclusions

          Despite evidence of emerging services, this survey describes barriers to ongoing development of perioperative medicine. Facilitators may include increased clinical exposure, targeted education and training and collaborative working with other specialties.

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          Most cited references10

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          Identification and characterisation of the high-risk surgical population in the United Kingdom

          Introduction Little is known about mortality rates following general surgical procedures in the United Kingdom. Deaths are most common in the 'high-risk' surgical population consisting mainly of older patients, with coexisting medical disease, who undergo major surgery. Only limited data are presently available to describe this population. The aim of the present study was to estimate the size of the high-risk general surgical population and to describe the outcome and intensive care unit (ICU) resource use. Methods Data on inpatient general surgical procedures and ICU admissions in 94 National Health Service hospitals between January 1999 and October 2004 were extracted from the Intensive Care National Audit & Research Centre database and the CHKS database. High-risk surgical procedures were defined prospectively as those for which the mortality rate was 5% or greater. Results There were 4,117,727 surgical procedures; 2,893,432 were elective (12,704 deaths; 0.44%) and 1,224,295 were emergencies (65,674 deaths; 5.4%). A high-risk population of 513,924 patients was identified (63,340 deaths; 12.3%), which accounted for 83.8% of deaths but for only 12.5% of procedures. This population had a prolonged hospital stay (median, 16 days; interquartile range, 9–29 days). There were 59,424 ICU admissions (11,398 deaths; 19%). Among admissions directly to the ICU following surgery, there were 31,633 elective admissions with 3,199 deaths (10.1%) and 24,764 emergency admissions with 7,084 deaths (28.6%). The ICU stays were short (median, 1.6 days; interquartile range, 0.8–3.7 days) but hospital admissions for those admitted to the ICU were prolonged (median, 16 days; interquartile range, 10–30 days). Among the ICU population, 40.8% of deaths occurred after the initial discharge from the ICU. The highest mortality rate (39%) occurred in the population admitted to the ICU following initial postoperative care on a standard ward. Conclusion A large high-risk surgical population accounts for 12.5% of surgical procedures but for more than 80% of deaths. Despite high mortality rates, fewer than 15% of these patients are admitted to the ICU.
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            Age of patients undergoing surgery

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              Frequency of surgical treatment and related hospital procedures in the UK: a national ecological study using hospital episode statistics.

              Despite evidence of high activity, the number of surgical procedures performed in UK hospitals, their cost and subsequent mortality remain unclear.
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                Author and article information

                Contributors
                Judith.partridge@gstt.nhs.uk
                Andyrog@doctors.org.uk
                Andrea.joughin@nhs.net
                d.walker@ucl.ed.ac.uk
                Jonathan.simon@doctors.org.uk
                Michael.swart@nhs.net
                Jugdeep.dhesi@gstt.nhs.uk
                Journal
                Perioper Med (Lond)
                Perioper Med (Lond)
                Perioperative Medicine
                BioMed Central (London )
                2047-0525
                21 January 2020
                21 January 2020
                2020
                : 9
                : 3
                Affiliations
                [1 ]GRID grid.239826.4, Perioperative Medicine for Older People Undergoing Surgery (POPS), Older Persons Assessment Unit, , Guy’s and St Thomas’ NHS Foundation Trust, Guy’s Hospital, ; Great Maze Pond, London, SE1 9RT UK
                [2 ]ISNI 0000 0001 2322 6764, GRID grid.13097.3c, Division of Primary Care and Public Health Sciences, Faculty of Life Sciences and Medicine, , King’s College London, ; London, UK
                [3 ]GRID grid.420545.2, Perioperative Medicine for Older People Undergoing Surgery (POPS), , Guy’s and St Thomas’ NHS Foundation Trust, ; London, UK
                [4 ]ISNI 0000 0004 0399 0118, GRID grid.413286.a, Department of Medicine for the Elderly, , Great Western Hospital, ; Marlborough Road, Swindon, UK
                [5 ]ISNI 0000 0004 0612 2754, GRID grid.439749.4, Anaesthesia and Critical Care Medicine, , University College London Hospitals, ; London, UK
                [6 ]ISNI 0000 0001 0693 2181, GRID grid.417895.6, Imperial College Healthcare NHS Trust, ; London, UK
                [7 ]ISNI 0000 0004 0399 0716, GRID grid.417173.7, Anaesthesia and Perioperative Medicine, , Torbay Hospital, ; Torquay, Devon TQ2 7AA UK
                [8 ]ISNI 0000 0004 0490 3952, GRID grid.464666.0, National Clinical Lead for the Perioperative Medicine Programme, , Royal College of Anaesthetists, ; London, UK
                [9 ]ISNI 0000 0001 2322 6764, GRID grid.13097.3c, Division of Primary Care and Public Health Sciences, Faculty of Life Sciences and Medicine, , King’s College London, ; London, UK
                Article
                132
                10.1186/s13741-019-0132-0
                6971857
                e2ce00b0-fde3-4b59-84a4-5880efb44294
                © The Author(s). 2020

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 7 July 2019
                : 25 November 2019
                Categories
                Research
                Custom metadata
                © The Author(s) 2020

                perioperative medicine,barriers and facilitators,service development,education and training

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