Perioperative care in adults

Quality statement

Adults have a clinical assessment before surgery.

Rationale

A clinical assessment that is appropriate for the adult and the proposed surgery can inform clinical judgement and support shared decision making. Adults having surgery may present with conditions that affect their overall health, such as anaemia, diabetes, frailty, dementia, chronic pain, or malnutrition. When conditions such as these are considered as part of a clinical assessment early in the perioperative period, decisions can then be made on how to best manage them before surgery, or whether they pose such a significant risk to the adult that surgery should be delayed, modified, or not carried out at all. Effective management of such conditions can improve surgical outcomes and recovery and reduce avoidable delays or cancellations when the adult may have otherwise not been well enough to have the planned 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 services) ensure that adults having surgery have a clinical assessment before surgery.

Healthcare professionals (such as doctors, nurses, dentists and allied health professionals) carry out a clinical assessment for the adult having surgery before deciding whether to proceed with the surgery as planned. The clinical assessment should occur early in the perioperative period. During the clinical assessment, consider whether the adult having surgery has any conditions affecting their overall health. If these are identified, plan for their effective management (such as information provision for self-management, further assessment, investigations or referral).

Commissioners ensure that they commission services in which adults having surgery have a clinical assessment 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 a clinical assessment before surgery that takes into account any conditions that affect overall health, and how these will be managed. The clinical assessment can help the adult make an informed decision as to whether surgery is the most appropriate treatment option for them.

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

Adults from more deprived areas may experience higher levels of health inequality, such as reduced access to healthcare provision or health promotion strategies. As a result, they are more likely to present with conditions such as diabetes, obesity, malnutrition and heart disease. Consideration may need to be given to socioeconomic status and deprivation when performing clinical assessments for adults having surgery.

Older adults are more likely to experience frailty and this can be identified through frailty scoring such as the implementation of a comprehensive geriatric assessment in the clinical assessment. Older adults are also at increased risk of malnourishment.

Women are at an increased likelihood of becoming iron deficient, and as a result may be at higher risk of surgical complications. This should be considered in the clinical assessment.

Adults with learning disabilities, impairment, or sensory loss, those who do not speak or read English, and those with low levels of literacy or numeracy may have difficulty communicating effectively with healthcare services, including expressing levels of pain. This should be factored into the clinical assessment.