By Claire Frank, Lead Pre-operative Assessment Pharmacist, Wrexham Maelor Hospital and former Centre for Perioperative Care Fellow

The problem with waiting

Surgical waiting lists are long, and the surgical population is becoming increasingly older, living with obesity or multiple health conditions. Worryingly 43% of patients report a deterioration in health whilst they wait for elective surgery.

Choosing surgical intervention should be a shared decision between the patient and the surgeon, taking into account the benefits, risks, alternatives and what happens if nothing is done. Deterioration associated with passive waiting means a patient may be less fit on the day of surgery than when they were listed - so the risks may now outweigh the benefits.

Surgery is a big decision. Complications occur in at least 10-15% of patients and 14% of patients regret choosing surgical intervention. For patients, complications mean a longer stay in hospital, a worse outcome from surgery or even an inability to return to their usual place of residence. For the NHS, complications result in more healthcare costs, delays in discharge affect patient flow and last-minute cancellations affect theatre productivity.

The benefit of preparing

A change in culture from waiting to preparation is key to improving patient outcomes, reducing complications and strengthening population health. The Centre for Perioperative Care (CPOC) reports that complications can be reduced by as much as 50% and hospital stays shortened by 1-2 days simply by better preparation for surgery.

CPOC have identified seven key areas to focus on:

1. Stopping smoking

2. Moderating alcohol intake

3. Increasing physical activity

4. Focusing on nutrition

5. Focusing on mental wellbeing

6. Optimising comorbidities (for example diabetes, anaemia and frailty)

7. Practical preparation to support with activities of daily living

Active preparation provides a positive focus for patients whilst they wait. Even better, lifestyle change introduced pre-operatively is often sustained long-term. Using this surgical teachable moment to empower patients to make lifestyle change can have a wider benefit to the NHS and population health by addressing health inequalities.

A call to action

Lifestyle changes benefit every patient, but especially those waiting for surgery.  Change takes time, and can’t wait until pre-operative assessment, which at best is months and at worst days before surgery.

Pharmacists and pharmacy technicians in all sectors are ideally placed to empower patients, promote active preparation and signpost to free, co-designed patient resources such as CPOC’s ‘What to ask, think about, and do if you might be having an operation’.

Simple brief interventions - whether during repeat prescription collection, chronic disease reviews, outpatient clinics or unscheduled hospital admissions - can make every contact with a pharmacy professional count. A minute of your time can have a huge impact on a patient’s surgical journey and future health.

Every contact counts. Next time you interact with a patient, neighbour or relative waiting for surgery, take the opportunity to turn waiting time into preparation time.

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