Dr Ali at podium in front of a slide reading
COMPLEX MEDICAL HISTORY HAVING MODERATE TO HIGH RISK SURGERY
. Significant Cardiac History. CCF with EF < 30%, severe valvular heart disease, severe IHD or medical therapy
. Respiratory failure. On home O2, FEV1 < 40% predicted
. Poor neurological function. Major CVA with significant deficits, debilitating neurological disease, significant cognitive impairment
. Renal failure. On dialysis or eGFR < 30
. Liver Failure. Child Pugh B or C
. Severely malnourished. Albumin < 25
. Morbidly obese. BMI > 50
FRAIL PATIENTS
Needing multidisciplinary input, e.g. geriatrics, ICU, allied health
POSSIBLE NON-BENEFICIAL SURGERY
0When we can help with making a decision not to proceed with surgery
Dr Riedel at podium in front of a slide with a pyramid captioned 'Multimodal Prehabilitation within a stepped care framework' and additional slide text-
UNIVERSAL PREHABILITATION (Bottom level)
SPECIALIST
PREHABILITATION (middle level)
Pre-frail
Malnourished
Deconditioned (unfit)
TARGETED PREHABILITATION (top level)
Frail
Sarcopenia
More gold #SPICA26- Dr Farheen Ali emphasizes referral to periop medicine services has to be *easy*. Simple tickboxes at Westmead ✅️. And Dr Bernhard Riedel talks about the prehabilitation pyramid and why the bottom level should be UNIVERSAL provision.
#MedTwitter