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Guidance seeks to reduce cancelled surgery due to raised blood pressure

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New guidance promoting close collaboration between primary and secondary care is designed to help reduce unnecessary cancellations for surgery because of a patient’s blood pressure.

The guidelines on the measurement of adult blood pressure and hypertension before elective surgery have been jointly published by the Association of Anaesthetists of Great Britain and Ireland and the British Hypertension Society.

“This will undoubtedly improve patient safety”

Mike Durkin

They said the guideline aimed to ensure that patients admitted to hospital for elective surgery were known to have blood pressures below 160mmHg systolic and 100mmHg diastolic in primary care.

The objective for primary care was to “fulfil this criterion before referral to secondary care for elective surgery”, while the objective for secondary care was to “avoid spurious hypertensive measurements”.

It represents the first time clinical guidance has been drawn up on the area, according to the two organisations – and is likely to be of interest to both practice nurses and pre-admission nurses.

The guidelines, published in the journal Anaesthesia, are intended to reduce unnecessary cancellations for surgery because of blood pressure.

The authors noted that such cancellations often resulted from different priorities – anaesthetists wanting to prevent complications from short term changes to blood pressure during the period of surgery, and clinicians concerned about the long term risks of the same complications.

“The new AAGBI and BHS guidelines give very clear and unambiguous directions to general practitioners and other members of the primary care team for referring patients to hospitals for surgery,” said the two organisations in a statement.

“Equally importantly, they give clear directions to anaesthetists and surgeons when to go ahead with surgery and when to ask patients to go back to their GPs for further investigation and treatment,” they added.

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Mike Durkin

Dr Mike Durkin, NHS England’s director of patient safety, backed the new guidance.

He said: “These new national guidelines from the AAGBI will ensure that patients with hypertension who need to undergo anaesthesia will be managed effectively and to current standards.

“This will be of huge benefit to patients and will undoubtedly improve patient safety through the collaborative work of healthcare clinicians in the general practice and hospital setting,” he added.

Key recommendations from the guidelines:

  • General practitioners should refer patients for elective surgery with mean blood pressures in primary care in the past 12 months less than 160mmHg systolic and less than 100mmHg diastolic
  • Secondary care should accept referrals that document blood pressures below 160mmHg systolic and below 100mmHg diastolic in the past 12 months
  • Pre-operative assessment clinics need not measure the blood pressure of patients being prepared for elective surgery whose systolic and diastolic blood pressures are documented below 160/100mmHg in the referral letter from primary care
  • General practitioners should refer hypertensive patients for elective surgery after the blood pressure readings are less than 160mmHg systolic and less than 100mmHg diastolic. Patients may be referred for elective surgery if they remain hypertensive despite optimal antihypertensive treatment or if they decline antihypertensive treatment
  • Surgeons should ask general practitioners to supply primary care blood pressure readings from the last 12 months if they are undocumented in the referral letter
  • Pre-operative assessment staff should measure the blood pressure of patients who attend clinic without evidence of blood pressures less than 160mmHg systolic and 100mmHg diastolic being documented by primary care in the preceding 12 months
  • Elective surgery should proceed for patients who attend the pre-operative assessment clinic without documentation of normotension in primary care if their blood pressure is less than 180mmHg systolic and 110mmHg diastolic when measured in clinic
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