Perioperative care in adults

  • Quality standard
  • QS216
  • Published: 

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Quality statement 5: Information and support for modifiable risk factors

Quality statement

Adults are given information and support to reduce their modifiable risk factors, before surgery.

Rationale

Adults having surgery may present for surgery with modifiable risk factors. Examples of modifiable risk factors include smoking, physical inactivity, excess alcohol consumption and comorbidities. Given suitable information and support, adults having surgery may choose to optimise their health before surgery by engaging in lifestyle modifications including stopping smoking, exercising more and reducing their alcohol consumption, and participating in services such as perioperative medicine for older people undergoing surgery (POPS). Acting on modifiable risk factors before surgery may reduce the risks associated with surgery that might otherwise lead to complications and an increased length of stay in hospital, or surgery being delayed or cancelled.

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.

Process

Proportion of adults having surgery who receive information and support to reduce their modifiable risk factors before surgery.

Numerator – the number in the denominator who receive information and support to reduce their modifiable risk factors before surgery.

Denominator – the number of adults having surgery.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from electronic patient records.

What the quality statement means for different audiences

Service providers (secondary and tertiary care services) ensure that systems are in place so that adults may reduce their modifiable risk factors before surgery. Ensure that healthcare professionals are aware of interventions and services that are available locally and nationally which support lifestyle changes or the management of comorbidities (such as prehabilitation, surgery school, treatment to stop smoking, or POPS).

Healthcare professionals (such as doctors, nurses and dentists) give information and support to adults having surgery so they may reduce their modifiable risk factors and optimise their health before surgery. Take an individualised approach that reflects the adult's needs and circumstances, including their ability to access services, personal preferences and coexisting conditions. Signpost adults to accessible services and interventions that support lifestyle modifications or the management of comorbidities (such as prehabilitation, surgery school, treatment to stop smoking, or POPS) to optimise the surgery, even if these are not provided locally. Refer adults having surgery to specialist services where appropriate.

Commissioners ensure that they commission services that can give information and support to adults so they may reduce their modifiable risk factors before surgery.

Adults having surgery receive information and support before surgery that may help to reduce any modifiable risks of surgery.

Source guidance

Perioperative care in adults. NICE guideline NG180 (2020), recommendations 1.1.1 and 1.3.2

Definitions of terms used in this quality statement

Adults having surgery

Adults who are booked for an elective or emergency surgical procedure, including dental surgery. [NICE's guideline on perioperative care in adults]

Information and support

Clear, accessible, evidence-based information alongside support which enables adults having surgery to understand their options, including the risks, benefits and consequences of each option, and participate in decisions about their perioperative care.

Examples of information and support available to reduce modifiable risk factors and optimise health before surgery from the Centre for Perioperative Care (CPOC) guidance on perioperative optimisation include:

  • assessment, optimisation, shared decision making

  • smoking cessation

  • exercise

  • alcohol moderation

  • practical preparation

  • nutrition

  • mental wellbeing

  • referral to specialist services.

[Adapted from CPOC guidance on perioperative optimisation: top seven interventions and expert opinion]

Modifiable risk factors

Examples include:

  • physical inactivity

  • smoking

  • overweight and obesity

  • excess alcohol consumption

  • poor nutrition

  • comorbidities.

[Adapted from the CPOC guidance on preoperative assessment and optimisation for adult surgery including consideration of COVID-19 and its implications (June 2021) and expert opinion]

Equality and diversity considerations

Adults from more deprived areas have worse outcomes after surgery than those living in less deprived areas, so further consideration should be given to information and support to reduce modifiable risk factors in this group. For instance, it may be more difficult for these adults to make dietary changes because of lack of access to, or the affordability of, nutritious foods, and as a result this group is more susceptible to poor nutrition. Adults with poor nutrition may present as underweight, overweight or obese and with mineral or electrolyte deficiencies, such as iron deficiency which can be a further barrier to surgery. Adults living in areas of greater deprivation may face multiple barriers to quitting smoking, such as limited financial resources, reduced access to services and lower confidence in making lifestyle changes. These challenges can delay smoking cessation and may result in longer waiting times for surgery, as adults who smoke are commonly advised to stop before proceeding with surgery. Adults from more deprived areas may be less able to advocate for services and interventions that support lifestyle modifications (such as bariatric and weight management services or smoking cessation support) or the management of comorbidities.