Optimising outcomes from elective surgery

Updated on 13 Mar, 2017

In September 2016 the CCG’s Governing Body approved the Vale of York Prevention and Better Health Strategy and discussed draft proposals to implement clinical thresholds for elective hip and knee joint surgery in the Vale of York.

Following the meeting, the CCG worked with NHS England to develop clinically appropriate criteria that asks:

  • patients with a BMI of 30 or above to lose weight before surgery and;
     
  •  patients recorded as a current smoker to quit smoking for at least two months before surgery.

Support and sources of help to meet the criteria are being offered to patients that require elective surgery.

Eating healthily, taking exercise and stopping smoking make a real difference to health and to the result of operations and the CCG views this as a key time to discuss with the changes that patients to help ensure that they have a safe and successful operation and are able to recover quickly.

There is no ban and no blanket policy. People who do not wish to access the support services or fail to meet the criteria will not be denied their elective procedure. Decisions about what is in the best interests of an individual’s health will be made on a case-by-case basis.

Exclusions

Local patients opting for elective surgery, but need to lose weight or quit smoking will receive help and support information including a range of resources here.

There are exclusions to the new measures and these are available here.

Obesity

Obesity is a recognised risk factor in surgery and surgical procedures. Research shows that obese patients are more likely to experience:

  • infection at the surgical site;
     
  • poor wound healing;
     
  • bleeding and blood clots in limbs and lungs;
     
  • breathing problems;
     
  • loosening, failure or dislocation of a new joint.

The NHS wants you to be aware of these risks so that you can take steps to minimise them before your procedure. If you need surgery and your weight is significantly higher than it should be, your doctor will explain the importance of losing weight before your operation or procedure can take place.

Even though you may feel fit and healthy at your current weight, studies show that patients with a higher body mass index (or BMI) are more likely to experience potentially serious complications both during and after surgery.

It is important to be in the best possible health before surgery. Patients with obesity are more likely to have certain diseases and conditions that increase the risks of surgery. If you have one of the following conditions, you will be asked to work with your GP to manage the condition so that it is kept under control before your procedure.

  • Cardiovascular disease, including high blood pressure
     
  • Type 2 diabetes
     
  • Obstructive sleep apnea
     
  • Metabolic syndrome—a group of health conditions that increase your risk for developing cardiovascular disease and type 2 diabetes.

Smoking

Following surgery, compared with ex-smokers and non-smokers, smokers are more likely to:

  • have pulmonary, circulatory, and infectious complications;
     
  • have reduced bone fusion and impaired wound healing;
     
  • be admitted to an intensive care unit;
     
  • have increased risk of in-hospital mortality; and
     
  • have an increased length of stay in hospital.

It is very important that you stop smoking before surgery. Even though you may feel fit and healthy as a smoker, studies show that patients who smoke, are more likely to experience potentially serious complications both during and after surgery.

Is this a ban for patients that smoke or are overweight?

No, this is not a ban. The policy helps to ensure that patients can optimise their own health outcomes by being in the best possible health for their surgery.

What if I have a question, who do I ask?

If you have a question you can contact the Patient Relations Team.

Phone 01904 555 999
Email voyccg.patientrelations@nhs.net
Write to
NHS Vale of York Clinical Commissioning Group,
West Offices, Station Rise, York YO1 6GA

www.aftermysurgery.org.uk

Since 2009, the NHS has been collecting patient-reported outcome measures (PROMs) for over 800,000 patients who have had elective surgery for unilateral hip or knee replacement or groin hernia repair. PROMs measure factors such as pain, mobility and mental well-being. Researchers at the University of York have analysed these data to identify patient groups that benefit differently from surgery.

Patients that are considering a hip or knee replacement or groin hernia repair can visit www.aftermysurgery.org.uk and see how patients like them have benefited from surgery.

The website is designed to be patient-friendly and easy to understand. It only takes a moment to fill in and can be used during consultations or by patients and their families at home.


Links to more information

What is BMI?

Why is the target weight loss set at 10%?

Why are patients asked to wait a year?

Why has the CCG got this policy?

Why is this policy different to others in the country?

What are the benefits?

Surgical risks – obesity

Surgical risks – smoking

Frequently asked questions

Why is the target weight loss set at 10%?

10% weight loss is a serious target. If patients can achieve this then that shows a commitment to a new lifestyle of activity and consuming fewer calories that will benefit overall health.

Popular slimming clubs encourage its members to lose 10% of their body weight.

The request to achieve this in a year is consistent with policies in other parts of the country.

When GPs prescribe the drug orlistat, to help with weight loss, patients are expected to lose 5% of their weight within three months and 10% of their weight within six months. We want to give patients longer to do this, if they need it, but once a weight loss of 10% is achieved if patients feel they still need an operation they will be added to the surgical waiting list. Sometimes as weight comes down and people get more active they feel they don’t need an operation just now.

Why are patients asked to wait a year?

We know it takes time to lose weight and for positive lifestyle changes to become firm habits. It’s not possible, or healthy, to lose a lot of weight rapidly. We want patients to have time to adopt a new lifestyle with a steady, healthy weight loss that will benefit them for many years to come.

Why has the CCG got this policy?

The policy forms an important part of the Vale of York Prevention and Better Health Strategy which aims to improve the health of the local population and the outcomes from any elective surgery they may need.

Why is this policy different to others in the country?

Many areas across England have a policy where patients are asked to reduce their BMI and stop smoking before surgery.

What are the benefits?

There are enormous benefits to reducing BMI and stopping smoking. These important lifestyle changes improve overall health and deliver better outcomes after surgery as explained below.

Surgical risks – obesity

Obesity is a recognised risk factor in surgery and surgical procedures. Research shows that obese patients are more likely to experience:

  •   infection at the surgical site;
  •   poor wound healing;
  •   bleeding and blood clots in limbs and lungs;
  •   breathing problems;
  •   loosening, failure or dislocation of a new joint.

The NHS wants you to be aware of these risks so that you can take steps to minimise them before your procedure. If you need surgery and your weight is significantly higher than it should be, your doctor will explain the importance of losing weight before your operation or procedure can take place.

Even though you may feel fit and healthy at your current weight, studies show that patients with a higher body mass index (or BMI) are more likely to experience potentially serious complications both during and after surgery.

It is important to be in the best possible health before surgery. Patients with obesity are more likely to have certain diseases and conditions that increase the risks of surgery. If you have one of the following conditions, you will be asked to work with your GP to manage the condition so that it is kept under control before your procedure.

  • Cardiovascular disease, including high blood pressure
  • Type 2 diabetes
  • Obstructive sleep apnoea
  • Metabolic syndrome—a group of health conditions that increase your risk for developing cardiovascular disease and type 2 diabetes.

There are risks associated with every surgery. However, some risks are greater for patients with obesity.

Complication

Reason

Risk

Anaesthesia

It is more difficult to give anaesthesia to a patient with obesity.

Complications may be due to the patient's body shape and anatomy, or linked to health conditions that can affect breathing.

More difficulty and pain putting in needles to give necessary medications.

Lack of sufficient oxygen and airflow.

Problems with getting needles in the right place for spinal and epidural nerve blocks and other types of regional anaesthesia.

Length of time for the operation

There are technical challenges associated with performing surgery on a patient with obesity, so operation times are often longer.

The longer in surgery, the greater the risk of complications.

Complications after surgery

Compared with a patient of normal weight, someone with obesity is more likely to experience complications after surgery.

Infection.

Poor wound healing.

Difficulty breathing.

Blood clots.

Pulmonary embolism (a blood clot in the lungs).

Other outcomes that can be affected

Joint replacement will help relieve your pain and enable you to live a fuller, more active life. However, if you have obesity, you may never achieve the increased mobility and range of motion experienced by a patient of normal weight.

Component loosening and failure.

Dislocation of the replacement joint, especially in the hip.

In some cases, a second ‘revision’ surgery may be necessary to remove failed implants and replace them with new ones.

Surgical risks – smoking

Following surgery, compared with ex-smokers and non-smokers, smokers are more likely to:

  • have pulmonary, circulatory, and infectious complications;
  • have reduced bone fusion and impaired wound healing;
  • be admitted to an intensive care unit;
  • have increased risk of in-hospital mortality; and
  • have an increased length of stay in hospital.

It is very important that you stop smoking before surgery. Even though you may feel fit and healthy as a smoker, studies show that patients who smoke, are more likely to experience potentially serious complications both during and after surgery.