Search

Cross specialty teams, including surgeons, anaesthetists, geriatricians and allied health professionals should be initiated to provide quality postoperative care to frail older surgical patients.²

All major head and neck surgery should be overseen by a named consultant or autonomously practising anaesthetist with a subspecialty interest in this area.⁷⁷

There should be funding for and provision of staff trained in postoperative monitoring of free tissue transfers and replanted tissues to reduce the incidence of flap failure.^47,78

When very long surgical procedures are scheduled on a regular basis, appropriate funding and resources should be in place to support lists of long duration.

Planned acute plastic surgery trauma lists should take place daily in working hours to prevent unnecessary overnight operating.⁶³

Patients should not unnecessarily undergo surgery at night. To prevent this, planned operating lists may be necessary in the evening and weekend, in addition to scheduled weekday trauma sessions.^63,79

Any scheduled plastic surgery trauma lists should be organised and staffed by senior anaesthetists and surgeons, working regularly in that area and without conflicting clinical commitments.⁶³

Departments should develop and regularly review burn and plastic surgery referral guidelines and major incident plans.⁶⁶

Agreed local clinical guidelines should be in use, produced by an appropriately constituted multiprofessional team comprising anaesthetists, specialist nurses, surgeons, critical care clinicians, pharmacists, specialty consultants or autonomously practising anaesthetists and managers. These guidelines should cover at least the following:

• airway management, including follow-up for difficult situations (both plastic surgery and burn reconstructive surgery)⁷⁶
• monitoring of free flaps^47...

Guidelines should be developed for the prevention, recognition and management of common postoperative geriatric complications and/or syndromes, including delirium, falls, functional decline and pressure areas.