Evaluation and perioperative optimization of the surgical patient
Seance of wednesday 14 february 2024 (Apport de la médecine polyvalente hospitalière dans un service de chirurgie)
DOI number : 10.26299/k8pm-p172/emem.2024.06.03
Abstract
The main function of the multi-skilled doctor in the surgery department is the medical care of patients in the perioperative period. This treatment consists of identifying weaknesses in order to anticipate post-operative decompensations and to manage these complications if they have not been avoided.
The surgical patient population is broadly divided into a portion of robust and healthy patients, who do not require care, and a portion of fragile patients, who should be identified.
Frailty concerns many areas (nutrition, cognition, autonomy, polypathology, etc.). Different strategies exist to detect fragility, more or less achievable in current practice. Management of these pathologies subject to decompensation makes it possible to significantly reduce postoperative morbidity and mortality, the rate of re-hospitalization, and the risk of entry into an institution.
Optimization of frail patients must be carried out preoperatively, peroperatively and postoperatively. It is implemented preoperatively via multimodal prehabilitation systems lasting at least 10-15 days, and by a blood-management strategy. Concerning the intraoperative, optimization is the responsibility of surgeons and anesthetists (also with a blood management strategy). Finally, post-operative optimization consists of taking care of decompensations and complications not avoided, and improving the recovery of functional capacities by the way of ERAS devices with multidisciplinary cooperation. All this care requires the involvement of all health stakeholders.
The surgical patient population is broadly divided into a portion of robust and healthy patients, who do not require care, and a portion of fragile patients, who should be identified.
Frailty concerns many areas (nutrition, cognition, autonomy, polypathology, etc.). Different strategies exist to detect fragility, more or less achievable in current practice. Management of these pathologies subject to decompensation makes it possible to significantly reduce postoperative morbidity and mortality, the rate of re-hospitalization, and the risk of entry into an institution.
Optimization of frail patients must be carried out preoperatively, peroperatively and postoperatively. It is implemented preoperatively via multimodal prehabilitation systems lasting at least 10-15 days, and by a blood-management strategy. Concerning the intraoperative, optimization is the responsibility of surgeons and anesthetists (also with a blood management strategy). Finally, post-operative optimization consists of taking care of decompensations and complications not avoided, and improving the recovery of functional capacities by the way of ERAS devices with multidisciplinary cooperation. All this care requires the involvement of all health stakeholders.