Advertisement

Fundamentals of Patient Preparation for the Operating Room in the Twenty-First Century

  • Emily A. Pearsall
  • Robin S. McLeod
Chapter

Abstract

Preoperative preparation is essential in order to optimize outcomes and decrease complications, mortality, and length of stay of the surgical patient. With the adoption of the concept of enhanced recovery after surgery, there is an increased emphasis on the preoperative phase of care recognizing that if patients are in optimal condition preoperatively, they are more likely to recover more quickly postoperatively. Patient education is also an important part of their care as there is also an increased emphasis on self-management in ERAS protocols.

Preoperative assessment of the patient is important in order to confirm the diagnosis and plan the procedure. This may include diagnostic imaging and laboratory tests. In addition, comorbidities such as diabetes and heart disease should be identified and treated if necessary. In recent years, there has been some evidence that the preoperative status of patients can be improved by considering smoking cessation, prehabilitation, nutritional supplements, and blood conservation when applicable. In addition, patients having colorectal surgery may have unique needs including mechanical bowel preparation and siting of stomas in those where a stoma is a possibility. Finally, there is greater emphasis on preparation on the day of surgery including introduction of shorter fasts and interventions to decrease surgical site infections and venous thromboembolisms. As well, surgical checklists which have been shown to increase communication in the operating room among members of the perioperative team are now a part of the routine in most centers.

Keywords

Enhanced recovery after surgery Preoperative assessment Patient education Guidelines 

Selected Readings

  1. Thomsen T, Villebro N, Møller AM. Interventions for preoperative smoking cessation. Cochrane Database Syst Rev. 2014;3:CD002294.Google Scholar
  2. Hathaway D. Effect of preoperative instruction on postoperative outcomes: a meta-analysis. Nurs Res. 1986;35:269–75.CrossRefPubMedCentralPubMedGoogle Scholar
  3. McLeod RS, Aarts MA, Chung F, Eskicioglu C, Forbes SS, Conn LG, McCluskey S, McKenzie M, Morningstar B, Nadler A, Okrainec A, Pearsall EA, Sawyer J, Siddiqui N, Wood T. Development of an enhanced recovery after surgery guideline and implementation strategy base on the knowledge-to-action cycle. Ann Surg. 2015;262:1016–25.CrossRefPubMedGoogle Scholar

References

  1. 1.
  2. 2.
    Zargar-Shoshtari K, Hill AG. Optimization of perioperative care for colonic surgery: a review of the evidence. ANZ J Surg. 2008;78(1–2):13–23.CrossRefPubMedCentralPubMedGoogle Scholar
  3. 3.
    Kiecolt-Glaser JK, Page GG, Marucha PT, MacCallum RC, Glaser R. Psychological influences on surgical recovery: perspectives from psychoneuroimmunology. Am Psychol. 1998;53(11):1209–18.CrossRefPubMedCentralPubMedGoogle Scholar
  4. 4.
    Devine EC. Effects of psychoeducational care for adult surgical patients: a meta-analysis of 191 studies. Patient Educ Couns. 1992;19(2):129–42.CrossRefPubMedCentralPubMedGoogle Scholar
  5. 5.
    Hathaway D. Effect of preoperative instruction on postoperative outcomes: a meta-analysis. Nurs Res. 1986;35:269–75.CrossRefPubMedCentralPubMedGoogle Scholar
  6. 6.
    Sibbern T, Bull Sellevold V, Steindal SA, Dale C, Watt-Watson J, Dihle A. Patients’ experiences of enhanced recovery after surgery: a systematic review of qualitative studies. J Clin Nurs. 2017;26(9–10):1172–88.CrossRefPubMedCentralPubMedGoogle Scholar
  7. 7.
    Weimann A, Braga M, Carli F, Higashiguchi T, Hübner M, Klek S, Laviano A, Ljungqvist O, Lobo DN, Martindale R, Waitzberg DL, Bischoff SC, Singer P. ESPEN guideline: clinical nutrition in surgery. Clin Nutr. 2017;36(3):623–50.CrossRefPubMedCentralPubMedGoogle Scholar
  8. 8.
    Burden S, Todd C, Hill J, Lal S. Pre-operative nutrition support in patients undergoing gastrointestinal surgery. Cochrane Database Syst Rev. 2012;11:CD008879.PubMedPubMedCentralGoogle Scholar
  9. 9.
    Karateke F, Ikiz GZ, Kuvvetli A, Menekse E, Das K, Ozyazici S, Atalay BG, Ozdogan M. Evaluation of nutritional risk screening-2002 and subjective global assessment for general surgery patients: a prospective study. J Pak Med Assoc. 2013;63(11):1405–8.PubMedPubMedCentralGoogle Scholar
  10. 10.
    Association of Anaesthetists of Great Britain and Ireland. Peri-operative management of the surgical patient with diabetes 2015. Anaesthesia. 2015;70:1427–40.CrossRefGoogle Scholar
  11. 11.
    Thomsen T, Villebro N, Møller AM. Interventions for preoperative smoking cessation. Cochrane Database Syst Rev. 2014;3:CD002294.Google Scholar
  12. 12.
    Santa Mina D, Clarke H, Ritvo P, et al. Effect of total-body prehabilitation on postoperative outcomes: a systematic review and meta-analysis. Physiotherapy. 2014;100(3):196–207.CrossRefPubMedCentralPubMedGoogle Scholar
  13. 13.
    Moran J, Guinan E, McCormick P, Larkin J, Mockler D, Hussey J, Moriarty J, Wilson F. The ability of prehabilitation to influence postoperative outcome after intra-abdominal operation: a systematic review and meta-analysis. Surgery. 2016;160(5):1189–201.CrossRefPubMedGoogle Scholar
  14. 14.
    Loojaard SM, Slee-Valentijn MS, Otten RH, Maier AB. Physical and nutritional prehabilitation in older patients with colorectal carcinoma: a systematic review. J Geriatr Phys Ther. 2017.  https://doi.org/10.1519/JPT.0000000000000125.
  15. 15.
    de Benoist B, McLean E, Egli I, editors. Worldwide prevalence of anaemia 1993–2005: WHO global database on anaemia. Geneva: World Health Organization; 2008.Google Scholar
  16. 16.
    WHO. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Vitamin and mineral nutrition information system. Geneva: World Health Organization; 2011. http://www.who.int/vmnis/indicators/haemoglobin.Google Scholar
  17. 17.
    Dunne JR, Malone D, Tracy JK, Gannon C, Napolitano LM. Perioperative anemia: an independent risk factor for infection, mortality, and resource utilization in surgery. J Surg Res. 2002;102(2):237–44.CrossRefPubMedCentralPubMedGoogle Scholar
  18. 18.
    Hill GE, Frawley WH, Griffith KE, Forestner JE, Minei JP. Allogeneic blood transfusion increases the risk of postoperative bacterial infection: a meta-analysis. J Trauma. 2003;54(5):908–14.CrossRefPubMedGoogle Scholar
  19. 19.
    Devon KM, McLeod RS. Pre and peri-operative erythropoeitin for reducing allogeneic blood transfusions in colorectal cancer surgery. Cochrane Database Syst Rev. 2009;1:CD007148.Google Scholar
  20. 20.
    Lidder PG, Sanders G, Whitehead E, Douie WJ, Mellor N, Lewis SJ, Hosie KB. Pre-operative oral iron supplementation reduces blood transfusion in colorectal surgery - a prospective, randomised, controlled trial. Ann R Coll Surg Engl. 2007;89(4):418–21.CrossRefPubMedCentralPubMedGoogle Scholar
  21. 21.
    Edwards TJ, Noble EJ, Durran A, Mellor N, Hosie KB. Randomized clinical trial of preoperative intravenous iron sucrose to reduce blood transfusion in anaemic patients after colorectal cancer surgery. Br J Surg. 2009;96(10):1122–8.CrossRefPubMedCentralPubMedGoogle Scholar
  22. 22.
    Henry DA, Moxey AJ, O’Connell D, Brown T, Fergusson DA, Carless PA. Pre-operative autologous donation for minimising perioperative allogeneic blood transfusion. Cochrane Database Syst Rev. 2010;1:CD001888.Google Scholar
  23. 23.
    Slim K, Vicaut E, Launay-Savary M, Contant C, Chipponi J. Updated systematic review and meta-analysis of randomized clinical trials on the role of mechanical bowel preparation before colorectal surgery. Ann Surg. 2009;249(2):203–9.CrossRefPubMedCentralPubMedGoogle Scholar
  24. 24.
    World Health Organization. Global guideline on the prevention of surgical site infection, November 2016. http://www.who.int/gpsc/ssi-prevention-guidelines/en/.
  25. 25.
    Salvadalena G, Hendren S, McKenna L, Muldoon R, Netsch D, Paquette I, Pittman J, Ramundo J, Steinberg G. WOCN society and ASCRS position statement on preoperative stoma site marking for patients undergoing colostomy or ileostomy surgery. J Wound Ostomy Continence Nurs. 2015;42(3):249–52.CrossRefPubMedCentralPubMedGoogle Scholar
  26. 26.
    Miller D, Pearsall E, Johnston D, Frecea M, McKenzie M. Ontario provincial ERAS enterostomal therapy nurse network. Executive summary: enhanced recovery after surgery: best practice guideline for care of patients with a fecal diversion. J Wound Ostomy Continence Nurs. 2017;44(1):74–7.CrossRefPubMedCentralPubMedGoogle Scholar
  27. 27.
    Merchant R, Chartrand D, Dain S, Dobson G, Kurrek MM, Lagace A, Stacey S, Thiessen B, Canadian Anaesthesiologists Society. Guidelines to the practice of anaesthesia-revised edition 2015. Can J Anaesth. 2015;62:54–67.CrossRefPubMedCentralPubMedGoogle Scholar
  28. 28.
    Smith I, Kranke P, Murat I, Smith A, O’Sullivan G, Soreide E, Spies C, In’t Vedl B, European Society of Anaesthesiology. Perioperative fasting in adults and children: guidelines from the European Society of Anaesthesiology. Eur J Anaesthesiol. 2011;28:556–69.CrossRefPubMedCentralPubMedGoogle Scholar
  29. 29.
    American Society of Anaesthesiologists. Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: updated report. Anesthesiology. 2011;114:495–511.CrossRefGoogle Scholar
  30. 30.
    Brady MC, Kinn S, Stuart P, Ness V. Preoperative fasting for adults to prevent perioperative complications. The Cochrane Collab. 2003;4:CD004423.Google Scholar
  31. 31.
    Tryba M, Zenz M, Mlasowsky B, Huchzermeyer H. Does stomach tube enhance regurgitation during general anaesthesia? Anaesthesist. 1983;32:407–9.PubMedPubMedCentralGoogle Scholar
  32. 32.
    Plourde G, Hardy JF. Aspiration pneumonia: assessing the risk of regurgitation in the cat. Can Anaesth Soc J. 1986;33:345–8.CrossRefPubMedCentralPubMedGoogle Scholar
  33. 33.
    Pre-operative carbohydrate loading or hydration: a review of clinical and cost-effectiveness, and guidelines. Ottawa: Canadian Agency for Drugs and Technologies in Health; 2016. Available from https://www.ncbi.nlm.nih.gov/books/NBK362272/.
  34. 34.
    Gustafsson UO, Nygren J, Thorell A, Soop M, Hellström PM, Ljungqvist O, Hagström-Toft E. Pre-operative carbohydrate loading may be used in type 2 diabetes patients. Acta Anaesthesiol Scand. 2008;52:946–51.CrossRefPubMedCentralPubMedGoogle Scholar
  35. 35.
    Haynes AB, Weiser TG, Berry WR, Lipsitz SR, Breizat AH, Dellinger EP, Herbosa T, Joseph S, Kibatala PL, Lapitan MC, Merry AF, Moorthy K, Reznick RK, Taylor B, Gawande AA, Safe Surgery Saves Lives Study Group. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med. 2009;360(5):491–9.CrossRefPubMedCentralPubMedGoogle Scholar
  36. 36.
    Urbach DR, Govindarajan A, Saskin R, Wilton AS, Baxter NN. Introduction of surgical safety checklists in Ontario, Canada. N Engl J Med. 2014;370(11):1029–38.CrossRefPubMedCentralPubMedGoogle Scholar
  37. 37.
    Haynes AB, Weiser TG, Berry WR, Lipsitz SR, Breizat AH, Dellinger EP, Dziekan G, Herbosa T, Kibatala PL, Lapitan MC, Merry AF, Reznick RK, Taylor B, Vats A, Gawande AA, Safe Surgery Saves Lives Study Group. Changes in safety attitude and relationship to decreased postoperative morbidity and mortality following implementation of a checklist-based surgical safety intervention. BMJ Qual Saf. 2011;20(1):102–7.CrossRefPubMedCentralPubMedGoogle Scholar
  38. 38.
    Umscheid CA, Mitchell MD, Doshi JA, Agarwal R, Williams K, Brennan PJ. Estimating the proportion of healthcare-associated infections that are reasonably preventable and the related mortality and costs. Infect Control Hosp Epidemiol. 2011;32(2):101–14.CrossRefPubMedCentralPubMedGoogle Scholar
  39. 39.
    Noorani A, Rabey N, Walsh SR, Davies RJ. Systematic review and meta-analysis of preoperative antisepsis with chlorhexidine versus povidone-iodine in clean-contaminated surgery. Br J Surg. 2010;97(11):1614–20.CrossRefPubMedCentralPubMedGoogle Scholar
  40. 40.
    Darouiche RO, Wall MJ Jr, Itani KM, Otterson MF, Webb AL, Carrick MM, Miller HJ, Awad SS, Crosby CT, Mosier MC, Alsharif A, Berger DH. Chlorhexidine-alcohol versus povidone-iodine for surgical-site antisepsis. N Engl J Med. 2010;362(1):18–26.CrossRefPubMedGoogle Scholar
  41. 41.
    Hypothermia: prevention and management in adults having surgery Clinical guideline [CG65]: National Institutes for Health and Care Excellence; 2008.Google Scholar
  42. 42.
    Forbes SS, Eskicioglu C, Nathens AB, Fenech DS, Laflamme C, McLean RF, McLeod RS, Best Practice in General Surgery Committee, University of Toronto. Evidence-based guidelines for prevention of perioperative hypothermia. J Am Coll Surg. 2009;209(4):492–503.e1.CrossRefPubMedCentralPubMedGoogle Scholar
  43. 43.
    Madrid E, Urrútia G, Roqué i Figuls M, Pardo-Hernandez H, Campos JM, Paniagua P, Maestre L, Alonso-Coello P. Active body surface warming systems for preventing complications caused by inadvertent perioperative hypothermia in adults. Cochrane Database Syst Rev. 2016;4:CD009016.PubMedPubMedCentralGoogle Scholar
  44. 44.
    Tanner J, Norrie P, Melen K. Preoperative hair removal to reduce surgical site infection. Cochrane Database Syst Rev. 2011;11:CD004122.Google Scholar
  45. 45.
    Geerts WH, Pineo GF, Heit JA, et al. Prevention of venous thromboembolism: the seventh ACCP conference on antithrombotic and thrombolytic therapy. Chest. 2004;126(3 Suppl):338S–400S.CrossRefPubMedGoogle Scholar
  46. 46.
    Geerts WH, Bergqvist D, Pineo GF, et al. Prevention of venous thromboembolism: American college of chest physicians evidence-based clinical practice guidelines (8th edition). Chest. 2008;133(6 Suppl):381S–453S.CrossRefPubMedCentralPubMedGoogle Scholar
  47. 47.
    Douketis JD, Spyropoulos AC, Spencer FA, Mayr M, Jaffer AK, Eckman MH, Dunn AS, Kunz R. Perioperative management of antithrombotic therapy: antithrombotic therapy and prevention of thrombosis, 9th ed: American college of chest physicians evidence-based clinical practice guidelines. Chest. 2012;141(2 Suppl):e326S–50S.CrossRefPubMedCentralPubMedGoogle Scholar
  48. 48.
    Kakkar VV, Corrigan TP, Fossard DP. Prevention of fatal postoperative pulmonary embolism by low doses of heparin. Lancet. 1975;2:45–51.Google Scholar
  49. 49.
    Yu HT, Dylan ML, Lin J, Dubois RW. Hospital’s compliance with prophylaxis guidelines for venous thromboembolism. Am J Health Syst Pharm. 2007;64:69–76.CrossRefPubMedCentralPubMedGoogle Scholar
  50. 50.
    Horlocker TT, Wedel DJ, Rowlingson JC, Enneking FK, Kopp SL, Benzon HT, Brown DL, Heit JA, Mulroy MF, Rosenquist RW, Tryba M, Yuan CS. Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: American society of regional anesthesia and pain medicine evidence-based guidelines (3rd edition). Reg Anesth Pain Med. 2010;35(1):64–101.CrossRefPubMedCentralPubMedGoogle Scholar
  51. 51.
    ASMBS. Prophlyactic measures to reduce the risk of venous thromboembolism in bariatric surgery patients. Surg Obes Relat Dis. 2007;3:494.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Zane Cohen Centre, Lunenfeld-Tanenbaum Research Unit, Mount Sinai HospitalTorontoCanada
  2. 2.Department of SurgeryUniversity of TorontoTorontoCanada
  3. 3.Institute of Health Policy, Management and Evaluation, University of TorontoTorontoCanada
  4. 4.Cancer Care OntarioTorontoCanada

Personalised recommendations