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Assessing Patients for Major Surgery: Risks and Factors

Explore risk stratification scoring systems, patient factors, and care effectiveness for optimal surgery outcomes. Learn about genetic, metabolic, and psychological impacts.

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Assessing Patients for Major Surgery: Risks and Factors

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  1. HOW DO WE ASSESS PATIENTS FOR MAJOR SURGERY? Gary Minto Consultant Anaesthetist www.bowelcancerwest.org.uk

  2. Surgical mortality, UK www.bowelcancerwest.org.uk

  3. Why Is Surgery Bad For You? • A Premeditated and Calculated Trauma • Mishaps, bleeding • Systemic Inflammatory Response • Increased VO2 (Fitness) • Hypercoagulability (Stents, DVT, stroke) • Metabolic Response (Diabetes, Renal) • Psychological (“Sickness”)

  4. Risk Stratification Scoring Systems ASA Lee Revised Cardiac Index APACHE Score POSSUM Score • Anaesthetic Hunch?

  5. A conceptual model for outcome following surgery Patient Factors + Effectiveness of Care + Random Variation = Outcome Iezzoni, L. I. An introduction to risk adjustment. Am J Med Qual 11, S8-11 (1996).

  6. A conceptual model for outcome following surgery Patient Factors + Effectiveness of Care + Random Variation = Outcome Comorbidity “aerobic fitness/ functional capacity” Genetics

  7. Hammill 2008

  8. Cardio-Pulmonary Exercise Testing (CPET)

  9. A conceptual model for outcome following surgery Patient Factors +Effectiveness of Care+ Random Variation severity of surgery , urgency what happens during surgery stress response (genetics)

  10. A conceptual model for outcome following surgery Patient Factors +Effectiveness of Care+ Random Variation = intra-op and post op complications response to complications / level of care decision-making process

  11. www.bowelcancerwest.org.uk

  12. www.bowelcancerwest.org.uk

  13. ANY QUESTIONS? www.bowelcancerwest.org.uk

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