Authors (including presenting author) :
Chan PF, Lai KPL, Wong SN
Affiliation :
Department of Family Medicine and Primary Health Care, Kowloon East Cluster (KEC)
Introduction :
Pre-operative assessment for surgery under general anaesthesia by anaesthesiologists frequently identifies various medical conditions which may increase peri-operative complication risk. Some of these conditions may cause last-minute deferral of surgery or increase the length of stay after surgery. Some of the conditions may even lead to major cardiopulmonary morbidity and mortality.
Traditionally, some of these medical conditions will require referral to Medical Specialist Out-patient Clinic (SOPC) for further evaluation and management. Some patients may not be able to receive timely assessment and management before the scheduled surgery. As a result, some patients would need deferral of their surgery or to proceed with the surgery without optimization of their medical conditions. As a result, a pilot Family Medicine Specialist led Pre-Operative Evaluation and Management (POEM) Clinic was set up in a TKOH General Out-patient Clinic (GOPC) in June 2024 to meet the service need.
Objectives :
1. To provide timely clinical evaluation and management for patients with newly diagnosed or known chronic medical conditions with suboptimal control before surgery
2. To provide fast-track special investigations including continuous glucose monitoring, ambulatory blood pressure monitoring, transthoracic echocardiography, and point-of-care ultrasound in the GOPC to reduce the need of referral to SOPC
3. To optimize patients’ peri-operative health conditions so as to reduce their peri-operative morbidity and mortality
Methodology :
13 medical conditions that could increase peri-operative morbidity and mortality were identified. An evidence-based clinical guideline was prepared. Inclusion and exclusion criteria and referral workflow were set up in collaboration with anaesthesiologists.
Clinical outcomes were evaluated by reviewing the clinical information of all patients attending the POEM Clinic from 12th June 2024 to 27th November 2024.
Result & Outcome :
Results:
34 out of 37 patients referred from anesthesiologists attended the POEM Clinic. Mean age of patients was 50.4 (37-83) years old. The common reasons for referral were newly diagnosed or suboptimal controlled diabetes mellitus (50%), followed by newly diagnosed or suboptimal controlled hypertension (35.3%), anaemia (8.8%) and thyroid dysfunctions (5.9%). The planned surgical operations included 11 surgical, 8 gynaecological, 8 ENT and 7 orthopaedics surgery. Only 3 (12.5%) patients required referral to SOPC for evaluation. None of the patients had to postpone their operation dates due to their referral reasons. Among the 19 patients with operation done, only 2 patients had mild post-operative complications (unknown infection and failed to wean off oxygen).
Conclusion:
Pre-operative evaluation and management of common medical conditions which affect peri-operative outcomes by family medicine specialists can reduce the need of referral to Medical SOPC. Timely assessment and management of these conditions can optimize patients’ clinical conditions and potentially surgical outcomes.
