Big risk for small hospitals
Experts say obese people face particular risks staying overnight at small hospitals.
The Australian and New Zealand College of Anaesthetists (ANZCA) has warned that obese patients and those with obstructive sleep apnoea can have their breathing suppressed by strong painkillers after surgery.
When this happens at small hospitals where there is no overnight physician, patients can die due to the lack of proper monitoring facilities.
“Small, private hospitals which have no on-site medical practitioners overnight and no intensive care backup must have robust pre-admission processes in which higher-risk patients are screened,” ANZCA president Professor David Scott said.
ANZCA recommends patients in rural and remote areas should make sure they go through the risks and benefits of having surgery in hospitals closer to home, which may not be so well equipped.
The warning has been issued as part of ANZCA’s Choosing Wisely initiative.
Its other main calls include urging patients to check with their doctors whether pre-surgery blood tests and chest X-rays are really necessary.
Professor Scott says a battery of standard tests are often ordered before an operation, when they may not in fact 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.
In particular, they warn patients aged over 70 having major surgery to fully 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 per cent dying within 30 days,” he said.