GP Portal

West Hampshire CCG

Search

More results...

Generic filters

Welcome to the GP Portal

Fit4Surgery

Resource

Optimising Health before Elective Surgery

Based on the evidence review for smoking cessation and weight reduction in the obese (BMI 30kg/m2 or above), it is recommended that all patients should be offered appropriate lifestyle change support before or at the time of referral for elective surgery and that this is consolidated and verified at assessment for elective surgery.

This is supported by the evidence that stopping smoking before elective surgery reduces the risk of intra- and postoperative complications, impaired wound healing and incidences of surgical site infections, which contribute to length of stays in hospital and the cost of health care.
It is also recommended that patients who are obese with a BMI of 30kg/m2 or above should be engaged in a behavioural change conversation. Obese patients should be signposted to self-help advice or offered referral to a specialist lifestyle behaviour change service for weight reduction support as appropriate.

There is good evidence and consensus that tobacco smoking remains the single greatest cause of preventable illness and premature death in England. Pulmonary or cardiovascular complications occur in up to 10% of elective surgery cases, with people who smoke having a considerably increased risk of intra- and postoperative complications. Patients who smoke have impaired wound healing and increased rates of surgical site infections (SSIs). SSI can double the length of time a patient stays in hospital and thereby increase the costs of health care.
Smoking is also the largest single cause of inequalities in health and accounts for about half of the difference in life expectancy between the lowest and highest income groups. Latest evidence suggests that 1 in 5 adults in England (20%) smoke cigarettes, with prevalence highest among those aged 20–24 and 25–34 (28% and 26% respectively). The prevalence of smoking in West Hampshire CCG population is 12.4%.
In August 2017, Cabinet supported the recommendation to adopt the Hampshire Priorities Committee Statement 21: Smoking in Non-urgent Surgery which recommends that:

  • Prescribing medication outside of supported programmes is low priority
  • Education through resources such as the National Centre for Smoking Cessation and Training (NCSCT – http://www.ncsct.co.uk/ ) is to be encouraged for all clinicians
  • All clinicians have a responsibility to undertake patient education and offer brief intervention with every contact
  • Use of e-cigarettes are less harmful and are preferable to smoking
  • Stopping smoking should be encouraged for at least 8 weeks prior to operation
  • Referral to a structured smoking cessation programme should be encouraged prior to, or at latest, at time of referral for surgical assessment, and
  • Evidence of active engagement with the programme or informed dissent must be evidenced before operative intervention.

There is good evidence that clinically obese people have a higher anaesthetic risk, limited evidence for increased wound infections, and mixed evidence that reducing weight before surgery reduces surgical complications or length of stay. However, excess weight [BMI 25.0–29.9 kg/m2 (overweight) and obesity (BMI ≥30.0 kg/m2) are important risk factors for anaesthetic problems and poorer surgical outcomes. Reports from the 2014 European Federation of National Associations of Orthopaedics and Traumatology (EFORT) included a statement noting that “obese people need knee replacements twice as often as people of normal weight and also face twice the risk of complications”. Patient’s weight is already a consideration in the Restricted Treatments and Procedures (RTAP) Policy for the management and treatment of hip and knee surgery. Prior approval is required for patients with a BMI over 35kg/m².
There is clear national guidance that getting to and maintaining a healthy weight (having a BMI between 20kg/m² to 24.9kg/m²) is beneficial to general health, reducing the risk of diabetes and hypertension. There is also consensus that weight management should be multidimensional and include behaviour change interventions.