20 Mar 2017

Obese patients at high risk in hospitals without overnight doctor

2:11 pm on 20 March 2017

Obese people and those with multiple health problems should avoid major operations in small private hospitals where there is no physician overnight, experts say.

A file photo of a patient in a hospital bed with an IV drip in the arm

Photo: 123RF

It is one of the key recommendations from the Australian and New Zealand College of Anaesthetists (ANZCA) as part of the Choosing Wisely initiative.

ANZCA president Professor David Scott said patients with obstructive sleep apnoea and obese patients were at high risk, particularly when given strong painkillers.

"This is because their breathing can be suppressed by opioids and they must be monitored carefully by skilled staff," he said.

He said the issue had been highlighted in a number of Australian state coroners' reports, where patients had died because hospitals did not have the facilities to ensure they could be properly monitored.

"Small, private hospitals which have no on-site medical practitioners overnight and no intensive care back-up must have robust pre-admission processes in which higher-risk patients are screened," he said.

ANZCA recommendations state patients in rural and remote Australia should weigh up the risk versus the benefits of having surgery in hospitals closer to home.

Check if pre-op tests are really needed, doctors say

As part of the Choosing Wisely initiative, patients are also being urged to ask their doctors whether pre-surgery blood tests and chest X-rays are really necessary.

Professor Scott said many health providers order a range of standard tests before an operation that might not be necessary.

"Pre-operative blood investigations in asymptomatic patients undergoing low risk surgery are of little value in detecting abnormalities that will alter patient management or improve outcomes," he said.

Patients aged over 70 having major surgery should discuss the risks of disability or death.

"It's a hard conversation to have but patients over 70 are at high risk of post-operative complications, with 5 percent dying within 30 days," he said.


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