Pre-op & Discharge Planning

Question 1

What are the aims of a pre-operative physio review?

Answer 1

• Understand the patient’s pre-operative mobility, functional level and social circumstances
• ‘Make Every Contact Count’: lifestyle advice​
  Education/mental preparation for what to expect post op​
• Giving him ownership/control of his own recovery: psychological benefit
• Empower the patients to be an active part in their post-op recovery

Question 2

What are some pre-op tests that must be done on patients?

Answer 2

• Diabetes
• HIN
• BMI/Lipid profile
• Thyroid disease
• Kidney function test (BUN, Creatine, GFR/eGFR)
• Neuromuscular disease/problems
• Peripheral vascular disease
• Liver function test
• Bladder screening
• Clotting disorders
• Allergies
• Complex needs
• Anaemia
• Age
• Review of lifestyle risk factors and advice around this: smoking, alcohol etc
• Review of cardiopulmonary symptoms (if any)
• ECG and/or echocardiogram
• Pulmonary function test/spirometry/full pulmonary assessment
• Exercise tolerance test/CPET
• Anaesthetic tests (done by anaesthetist)
• Others

Question 3

What should physios do pre-op?

Answer 3

• Teach ACBT
• Teach bed exercises
• Discuss expected mobility progress
• Discuss participation in cardiac rehabilitation
• If CABG: teach sternal precautions
  (if ortho teach any related joint precautions, practice with walking aids e.g NWB, ?equipment for discharge)
• Pre-op exercise programmes

Question 4

What does ERAS stand for?

Answer 4

Enhanced Recovery after Surgery

Question 5

What are the aims of enhanced recovery after surgery (ERAS)?

Answer 5

To reduce stress to body during surgery, increase patient participation in recovery, and reduce length of stay

Question 6

What is the pathway for enhanced recovery after surgery (ERAS)?

Answer 6

• Preoperative assessment, planning & preparation
• Reducing the physical stress of the operation
• Structured approach to post op care/management
• Early mobilisation

Question 7

What does POD stand for?

Answer 7

Post-op day

(e.g.: POD 1, POD 2, etc.)

Question 8

What day do you mobilise & treat your patient post-op and why?

Answer 8

Post-op day (POD) 0.

• because we want to get them moving as soon as possible
• wouldn’t POD 0 if complication in surgery (i.e. haemmorhage) or if still drowsy from anaesthetic

Question 9

What are some examples of bed exercises you can teach your patient post-op?

Answer 9

• Clamming
• Glute bridges
• Rolling
• Plantar flexion/dorsi flexion (for calves)

Question 10

What are some non-modifiable patient risk factors for post-op lung infection?

Answer 10

• Age
• Male sex
• ASA
• Functional dependence (frailty)
• Acute respiratory infection (within 1 month)
• Impaired cognition
• Impaired sensorium
• Cerebrovascular accident
• Malignancy
• Weight loss >10% (within 6 months)
• Long-term steroid use
• Prolonged hospitalisation

Question 11

What are some modifiable patient risk factors for post-op lung infection?

Answer 11

• Smoking
• COPD
• Asthma
• CHF
• OSA
• BMI < 18.5 or > 40kgm-2
• Hypertension
• Chronic liver disease
• Renal failure
• Ascites
• Diabetes mellitus
• Alcohol
• GORD
• Pre-op sepsis
• Pre-op shock

Question 12

What are some laboratory risk factors for post-op lung infection?

Answer 12

• Urea > 7.5 mmol litre-1
• Increased creatinine
• Abnormal liver function tests
• Low pre-op O2 saturation
• ‘Positive cough test’
• Abnormal pre-op CXR
• Pre-op anaemia (<100 g litre-1)
• Low albumin
• Predicted maximal O2 uptake
• FEV1:FVC <0.7 and FEV1 <80% of predicted

Question 13

What must be considered when discharge planning?

Answer 13

• Pain controlled?
• Obs stable?
• Aware of further exercises/precautions/advice?
• Home set up/support
• Mobile
• Level of function needed ?mobility ?stairs ?-ADLs
• Follow up arranged e.g. cardiac rehab
• MDT approach