Perioperative care in adults

Quality statement

Adults have an assessment of perioperative risk, with a validated risk stratification tool, before surgery.

Rationale

The assessment of perioperative risk in adults before they have surgery, using a validated risk stratification tool, is an important component of surgical treatment planning and supports the delivery of optimal perioperative care. It helps to establish the risks of having the procedure (such as morbidity and mortality) and whether the procedure should proceed as planned, be modified, or whether non-surgical options should be considered. It can also help frame discussions about lifestyle changes that adults may choose to make before surgery to optimise their health and reduce the risks associated with surgery. Assessing adults early in the perioperative period can inform decisions about the frequency and timing of clinical assessments. Risk assessment tools are validated for the surgical speciality and setting (elective or emergency care), so the appropriate risk stratification tool should be used for the adult having surgery.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured and can be adapted and used flexibly.

What the quality statement means for different audiences

Service providers (secondary and tertiary care services) ensure that adults have an assessment of perioperative risk with a validated risk stratification tool before surgery.

Healthcare professionals (such as doctors, nurses and dentists) carry out an assessment of perioperative risk for the adult having surgery before deciding whether to proceed with the surgery as planned. Use a validated risk stratification tool that is appropriate for both the surgical speciality and setting (elective or emergency care). Assess perioperative risk as early as possible and use the findings to inform decisions about the timing and frequency of clinical assessment and optimisation of the adult before surgery. Healthcare professionals should be aware of the limitations with using risk stratification tools, such as underestimating or overestimating perioperative risk, which may lead to insufficient attention to preventable risks or monitoring, surgery being done when alternative non-surgical options may be more appropriate, or unnecessary vigilance and a reluctance to proceed with surgery. Clinical judgement should complement the assessment to ensure the accurate assessment of perioperative risk.

Commissioners ensure that they commission services in which adults having surgery have an assessment of perioperative risk with a validated risk stratification tool before surgery. Ensure clear pathways exist for healthcare professionals to access senior decision makers, with defined routes and escalation points for concerns.

Adults having surgery have an assessment of perioperative risk before surgery to identify their risks of surgery. The assessment should help them make an informed decision as to whether surgery is the most appropriate treatment option.

Source guidance

Perioperative care in adults. NICE guideline NG180 (2020), recommendation 1.3.1

Definitions of terms used in this quality statement

Equality and diversity considerations

Validated risk stratification tools are useful to supplement clinical assessment, but no risk stratification tool is 100% accurate. Since many risk stratification tools do not take into account deprivation, frailty, disability, ethnicity or sex (including gender reassignment) for the adult having surgery, clinical judgement should complement the assessment of perioperative risk to ensure the accurate assessment of the risks of surgery.