Introduction
The volume of Surgery and Long Wait Times
A More Complex Perioperative Population
Inequalities in Healthcare
Defining Postoperative Outcomes
Traditional Outcome Measurements
A Move from Mortality Measurement to Morbidity Outcome Measurement
A Need for Patient-Reported Outcome Measurements (PROMs)
Defining Long-Term Postoperative Outcomes
Chronic Disease and Optimization of Functional Status
Defining Chronic Disease
Defining Functional Status
WHO Performance Classification | Definition |
---|---|
0 | Able to carry out normal activities without restriction |
1 | Restricted in strenuous activity, but ambulatory and able to carry out light work |
2 | Ambulatory and capable of all self-care but unable to carry out any work activities; up and about more than 50% of waking hours |
3 | Symptomatic and in a chair or in a bed for greater than 50% of the day but not bedridden |
4 | Completely disabled, cannot carry out any self-care, totally confined to bed or chair |
LTCs Category 1: Behavioural, Composite or “Non-medical” Chronic Conditions and Their Management in the Preoperative Period
Deconditioning or Loss of Functional Status
Functional Capacity
Smoking and Alcohol Consumption
Obesity
Poor Nutrition
Frailty and Its Management in the Preoperative Period
Polypharmacy
Chronic Pain/Opioid Dependency
Cognitive and Psychological
Patient Activation
LTCs Category 2: Individual Comorbidities
Long-term conditions category 1: behavioural, composite, or “non-medical” chronic conditions | ||||||||
Chronic pain | Deconditioning | Depression and anxiety | Frailty | Obesity | Opioid dependence | Poor nutrition | Polypharmacy | Smoking and alcohol consumption |
Long-term conditions category 2: individual comorbidities | ||||||||
Cardiac disease | Respiratory disease | Vascular disease | Liver disease | Renal disease | Neurological disease | Multi-system disease | ||
Heart failure | Asthma | Peripheral vascular disease | Alcoholic Liver disease | Chronic Kidney disease | Dementia | Anaemia | ||
Hypertension | COPD | Hepatitis | End-stage renal failure | Previous Stroke | Cancer | |||
Myocardial Infarction | OSA | Liver failure | Diabetes | |||||
Non-alcoholic fatty liver disease (NAFLD) |