• Guideline - NCEPOD
    Link:hqip.org.uk/assets/NCAPOP-Library/CORP-Library/2011-NCEPOD-Peri-Operative-CareKnowing-the-RiskFinal-Report.pdf
    • Findings
      • Intra-op monitoring for high risk patients rarely included co monitoring
      • ITU was the post-op location for only 1/5 high risk patients
      • High risk group 30 day mortality was 7% which incorporated 3/4 of post op deaths
      • Care was good in less than half of patients
      • Substantial number of high risk patients were ASA1/2
      • 50% of high risk surgical patients who died never went to a critical care environment
      • 2/3 of high risk patients were overweight
      • Inadequate intra-op monitoring was associated with a 3-fold increase in mortality
    • Recommendations
      • All high risk elective patients should be seen in pre-op clinic
      • Greater assessment of nutritional status
      • High risk patients should be fluid optimised in critical care environment
      • High risk enhanced recovery programme
      • Urgent address of provision of post-op care
    • Significant organisational factors
      • Only 2/3 of hospitals had 24/7 recovery
      • 1/3 have no CCOT
      • 16% had no anaesthetic pre-op clinic
      • 17% had no surgical pre-op clinic
      • Only 40% had access to CPEX testing
      • 1/3 had no policy on prevention of peri-op hypothermia