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Obese & Elderly Should Quiz Doctors About Surgery

Obese and elderly should quiz doctors about surgery: anaesthetists

Surgical options for people with medical conditions including obesity, and the risks of operating on the elderly, feature among five recommendations from the Australian and New Zealand College of Anaesthetists (ANZCA) being launched today (Thursday August 24) as part of the Choosing Wisely New Zealand initiative.

Choosing Wisely is a global initiative that asks the medical profession to focus on areas where evidence shows that a test, treatment or procedure provides little or no benefit to a patient and could even cause harm, so that patients and health professionals can have well-informed conversations around the patient’s treatment options, leading to better decisions and improved outcomes.

ANZCA recommends that patients with “significant co-morbidities” should have their surgeries in hospitals that are staffed and equipped for high-risk patients.

Dr Dick Ongley, a Christchurch anaesthetist who helped develop ANZCA’s recommendations, said: “Patients with obstructive sleep apnoea and obese patients are at high risk, particularly when their pain management includes opioid analgesics. The opioids can suppress their breathing and they must be monitored carefully by skilled staff.”

The hospital must have appropriate staff and resources for the particular patient and their proposed surgery: “Patients and doctors must consider staffing ratios and skill sets required for monitoring, medical support and high dependency unit care, as well as optimal pain management,” he said.

ANZCA also recommends doctors weigh the benefits of giving anaesthesia to patients with limited life expectancy, or patients at high risk of death or severely impaired recovery. It says doctors should first discuss these risks and benefits with the patient concerned.

The college warns that many patients aged over 70 are at high risk for problems after surgery, with 20 per cent experiencing complications within five days, 10 per cent needing to be admitted to critical care and five per cent dying within 30 days.

“Discussion with the patient and family about the risks and benefits of hospitalisation and surgery in this context are important,” Dr Ongley said. “Quality of life is an important part of this discussion.”

ANZCA’s other recommendations include that:

Pre-surgery tests including blood investigation and chest X-rays should not be routine but be ordered only when the patient’s condition requires it.

Cardiac stress-testing should not be routinely required for patients with no symptoms who are having low or intermediate risk cardiac surgery.

Blood transfusions should not be given to otherwise healthy young patients with a haemoglobin count of above 70 grams per litre who do not have ongoing blood loss.

Dr Ongley said: “Our recommendation is to avoid blood transfusions in patients with haemoglobin of 70 or more grams per litre, as there is no evidence of benefit and there are risks in administering a blood transfusion to young healthy patients with stable blood flow.”

Full detail about ANZCA’s recommendations is available here.

About ANZCA

The Australian and New Zealand College of Anaesthetists (ANZCA) is the professional organisation for about 6400 (about 740 in New Zealand) specialist anaesthetists (Fellows), and 1500 (about 250 in New Zealand) anaesthetists in training (trainees). One of Australasia's largest specialist medical colleges, ANZCA is responsible for the training, examination and specialist accreditation of anaesthetists and pain medicine specialists and for the standards of clinical practice in Australia and New Zealand.

Launch

The formal launch in New Zealand is at 3.30pm on Thursday, August 24, at the conclusion of a meeting of the Council of Medical Colleges, being held at The Wellington Club, Level 6, 88 The Terrace, Wellington.


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