Singapore, 28 July 2020 – Preparing for surgery is like getting ready for a marathon. The fitter and better prepared one is, the faster and better recovery will be. And that is what the Perioperative Programme for Elderly (PREPARE) designed by Singapore General Hospital (SGH) aims to do – enhance general health and well-being of frail elderly patients before they undergo major surgery.
Studies have shown that being frail puts an elderly patient at greater risk of developing surgical complications such as longer hospital stay, hospital readmissions, and possibly even death. In 2019 alone, approximately 9,400 elderly aged 65 years and above underwent elective surgery at SGH, and the number, including those who are frail, will continue to rise as Singapore’s population ages rapidly.
"Imagine running a marathon without training. The ability to complete the race is questionable and recovery will be long and painful. This is why competitive marathoners work with a team of experts to ensure they are in top form when they race. The idea of PREPARE is similar. We assembled a team to prep our elderly patients so that they can withstand the stress of surgery, and have an uneventful and shorter recovery," said Dr Hairil Rizal Abdullah, Senior Consultant, Department of Anaesthesiology, SGH, who led the team that introduced PREPARE at the Hospital’s Pre-Admission Centre (PAC) in January 2019.
The PREPARE team comprises anaesthesiologists, physiotherapists, internal medicine specialists, nurses and, dietitians. They are embedded in PAC so that elderly patients aged 65 years and above undergoing major surgery will receive mandatory screening in the same location and on the same day as their pre-surgery assessment.
A nurse will first screen the patient using a questionnaire which takes less than five minutes to complete. Their reviewing anaesthesiologists will then draw up a personalised plan and refer patients to other members of the PREPARE team depending on their needs. They may see a physiotherapist who will further assess them and teach them exercises that they can do at home pre- and post-surgery. They may also see a dietitian for nutrition optimisation, and an internal medicine specialist to stabilise their pre-existing chronic medical problems, if necessary.
After surgery, the PREPARE team will continue to review the patients in the wards to ensure continuity of care.
To measure the beneficial impact of the interventions, the team compared the care outcomes of about 40 patients from January to December 2019 who went through PREPARE with nearly 90 patients from January to June 2018 who did not. These patients were aged 65 years and above who had major abdominal surgery. They discovered that the PREPARE cohort were discharged two to three days earlier, and had a 10 to 20 per cent reduction in hospital bill. There was also about 25 per cent more patients in the PREPARE cohort who had no complications during hospitalisation.
To date, close to 120 elderly patients have gone through PREPARE, which has clinched this year’s Care Redesign Best Practice Medal at the National Healthcare Innovation and Productivity Awards in July.
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Ms Carol Ang
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