Our Summary

This research paper discusses how the process of evaluating older and sicker patients before chest surgeries has improved. It stresses the importance of early risk assessment in making informed decisions that will lead to better health outcomes. The paper mentions that recent studies have shown many risk factors can impact a patient’s survival rate beyond what typical medical tests, like lung function tests, can predict. In particular, a holistic evaluation of a patient’s overall health, like frailty assessments, can provide important information about their chances of surviving after a lung operation. The paper concludes that comprehensive risk assessment by anesthetists can guide the best course of clinical treatment. This involves actions taken before, during, and after surgery by a team of healthcare providers, resulting in an ‘Early Risk Stratification and Strategy’ (‘ERSAS’) pathway.

FAQs

  1. What is the purpose of early risk stratification in thoracic surgery?
  2. What recent findings have been made in relation to risk factors in thoracic surgery?
  3. What does the Early Risk Stratification and Strategy (‘ERSAS’) pathway include in terms of clinical treatment?

Doctor’s Tip

A helpful tip a doctor might tell a patient about thoracic surgery is to ensure they undergo a comprehensive preoperative evaluation to assess their overall health and potential risk factors. This may include assessments of lung function, cardiac risk, and functional status such as frailty assessments. By undergoing this thorough evaluation, patients can receive tailored care and interventions before, during, and after surgery to optimize their outcomes. It is important for patients to communicate openly with their healthcare team and follow their recommendations to ensure the best possible results from their thoracic surgery.

Suitable For

Patients who are typically recommended for thoracic surgery include those with:

  • Lung cancer
  • Esophageal cancer
  • Mediastinal tumors
  • Thoracic outlet syndrome
  • Pleural diseases (such as pleural effusion or pleural mesothelioma)
  • Severe lung infections or abscesses
  • Chest wall deformities
  • Hyperhidrosis (excessive sweating)
  • Tracheal or bronchial stenosis (narrowing)
  • Congenital abnormalities of the chest or lungs

It is important for patients to undergo a thorough preoperative evaluation to assess their overall health and determine their eligibility for surgery. This evaluation may include tests such as lung function tests, cardiac evaluations, and assessments of functional status and frailty. The goal of this evaluation is to identify any potential risk factors that may impact the patient’s surgical outcomes and to develop a personalized treatment plan to optimize their chances of a successful surgery and recovery.

Timeline

Before thoracic surgery:

  • Patient is evaluated by a multidisciplinary team including anaesthesiologists, surgeons, and other healthcare providers.
  • Comprehensive preoperative assessments are conducted, including lung function tests, cardiac risk index evaluation, and frailty assessments.
  • Risk factors for mortality and morbidity are identified beyond traditional medical findings.
  • A personalized treatment plan is developed based on the patient’s individual risk profile.

After thoracic surgery:

  • Peri-operative and postoperative interventions are implemented according to the Early Risk Stratification and Strategy (‘ERSAS’) pathway.
  • Patients receive appropriate monitoring and care to manage potential complications and optimize recovery.
  • Long-term survival is linked with holistic patient assessments, including functional status and frailty.
  • Regular follow-up appointments and monitoring are scheduled to ensure the patient’s continued recovery and well-being.

What to Ask Your Doctor

  1. What specific risk factors do I have that could impact my outcome after thoracic surgery?
  2. How will my functional status, such as frailty, be assessed before surgery?
  3. What is the overall goal of the Early Risk Stratification and Strategy pathway for my treatment?
  4. What preoperative interventions or treatments might be recommended for me based on my individual risk factors?
  5. How will my postoperative care be managed to optimize my recovery and long-term survival?
  6. Are there any alternative treatment options or less invasive procedures that could be considered for my condition?
  7. What is the expected timeline for my recovery and return to normal activities after thoracic surgery?
  8. What are the potential complications or risks associated with the surgery, and how will they be managed?
  9. How will my progress be monitored and evaluated after surgery to ensure the best possible outcome?
  10. Are there any lifestyle changes or additional resources that could help improve my overall health and recovery after thoracic surgery?

Reference

Authors: Starke H, von Dossow V, Karsten J. Journal: Curr Opin Anaesthesiol. 2022 Feb 1;35(1):61-68. doi: 10.1097/ACO.0000000000001086. PMID: 34860702