A series of short articles on key topics in perioperative medicine, published in the British Journal of Hospital Medicine

POM in a Nutshell


Postoperative cognitive dysfunction

Dr C Sathananthan Consultant Anaesthetist, Department of Anaesthetics, Guys and St. Thomas’ Hospital London NHS Foundation Trust

08 Jun 2018

Some patients emerge from surgery and anaesthesia with noted deficits in cognitive function that were not present preoperatively. This cognitive impairment – postoperative cognitive dysfunction – is a recognized clinical phenomenon in patients undergoing major cardiac and non-cardiac surgery (Rundshagen, 2014). It represents a decline in neuropsychological domains including memory, executive functioning and speed of processing (Tsai et al, 2010).


Cardiopulmonary Exercise Testing

Dr Catrin Williams ST7 Anaesthetics, Department of Anaesthetics, Morriston Hospital, Swansea SA6 6NL

08 April 2018

Cardiopulmonary exercise testing is a non-invasive test providing objective information about the cardiovascular, pulmonary and muscle function under physiological stress and the ability to deliver oxygen to peripheral tissues (Wasserman et al, 2004). Increasingly cardiopulmonary exercise testing is being used for preoperative risk assessment and to enable shared decision-making conversations with patients (Huddart et al, 2013).


The Perioperative Quality Improvement Programme: improving outcomes

Dr D Gilhooly & Dr SR Moonesinghe, Royal College of Anaesthetists, London

12 Feb 2018

The Perioperative Quality Improvement Programme has been set up as a multidisciplinary initiative to look at the quality of care and outcomes of patients undergoing major surgery in the NHS. Its aim is to reduce variation while effecting an overall improvement in morbidity.



Dr Catherine A Britton-Jones, Morriston Hospital, Swansea

14 Dec 2017

Prehabilitation is the process of enhancing a patient's ability to cope with particular stressors. Morbidity and mortality after elective surgery remain significant despite advances in anaesthetic and surgical techniques (Levett et al, 2016). By initiating prehabilitation programmes patients may be more receptive to implementing behavioural and lifestyle changes to improve their perioperative journey.


Enhanced recovery: pathways to better care

Dr Aoife Hegarty & Dr Nirav Shah, St George’s Hospital London

11 Oct 2017

Enhanced recovery after surgery comprises clinical pathways which aim to improve the quality of perioperative care and accelerate recovery. Benefits of enhanced recovery after surgery include reduced postoperative morbidity (Greco et al, 2014) and shorter length of stay, leading to reduced costs, greater throughput of patients and greater patient satisfaction. The underlying principles are reducing the surgical stress response and maintaining normal postoperative physiological functions. Strict adherence to the entire pathway produces better aggregate outcomes than implementing individual components (Gustafsson et al, 2011).

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