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Part of the Quality Improvement Working Group’s (QIWG) role is to deliver the College’s Quality Improvement (QI) strategy. To accomplish this, we have been working to strengthen the Quality Network (QN), plan projects and events to promote QI development, and consider how best to engage members.

Context

After previously focusing on the QI compendium¹ and facilitating resource sharing during the COVID pandemic, this year the QIWG has worked to assess and strengthen the QN. Our ‘Prep, Stop, Block’ project was part of this strategy, a summary of which was included in July’s Bulletin,² with the full report available on the our website.

Authors:

• Dr Ee-Neng Loh, Anaesthetic NELA fellow
• Ms Lyndsay Pearce, NELA Surgical/ Research Lead
• Dr Sarah Hare, Deputy Director RCoA Centre for Research and Improvement 

Email the NELA team

The challenges of providing care for an aging surgical population require no further introduction. Perioperative clinical teams are often managing surgical patients with multiple complex co-morbidities, higher levels of frailty, and poorer physiological reserve.

In the eighth annual report of the National Emergency Laparotomy Audit (NELA), we found that more than half of the patients undergoing emergency laparotomy (EL) were 65 years old or more, and that around 20% were aged over 80 years.¹ Despite improvements in perioperative care, one in ten patients die within 30 days of their surgery and mortality risk doubles in patients living with frailty.^1,2 Are we doing more harm than good by subjecting these patients to surgery?

This year, Santa turns 2,403 years old. Although Greek by birth, the modern-day figure of Santa is based on images drawn by American cartoonist Nast in 1863 from the description given in the poem “ 'Twas the Night Before Christmas”, first published by Moore in 1823. 

During a typical 85-year lifespan, the average American requires 9.17 surgeries. It’s not inconceivable, therefore, that with his rather risky lifestyle, Santa, too, may one day need to go under the knife.

Santa may be reluctant to take time away from work, but thinking of the not-impossible event that he ever requires surgery (perhaps due to Tim Allen-esque trauma), I have started to risk-stratify the jolly old man. Should Santa experience an untimely demise perioperatively, not only will millions of children no longer wake to gifts under the tree, but in true Santa Claus™ style, someone in the hospital might be required to eternally take up his mantle, and the rota in our hospital is difficult enough to staff as it is.