Case

During the pre-operative assessment before elective surgery of a patient with multiple medical comorbidities, no physical examination was undertaken. Despite an ejection systolic murmur being documented several times in the notes, an ECHO had never been requested. The patient died of post-operative complications that might have been foreseen had their severe aortic stenosis been diagnosed.

Commentary

Although not all patients require a physical examination, frail and older patients should be provided with a comprehensive assessment by a multidisciplinary team involving anaesthetists, surgeons and geriatricians. This is set out in detail in the RCoA’s GPAS document (Chapter 2, section 12.29)¹ and the guideline by CPOC which is supported by the NHS Elect perioperative care of older people undergoing surgery (POPS) programme.³ 

References

1. Royal College of Anaesthetists. Guidelines for the Provision of Anaesthetic Services. Chapter 2: Guidelines for the Provision of Anaesthesia Services for the Perioperative Care of Elective and Urgent Care Patients (2024)

2. Centre for Perioperative Care. Preoperative assessment and optimisation guidance (2021)