Authors (including presenting author) :
TAM OY (1), LAM KM (2), CHENG CP (2), LAU CW (2), YAU SK (2), KWAN WS (1), MAK MY (1)
Affiliation :
(1) Department of Physiotherapy, TMH (2) (2) Department of Anaesthesia and Operation Theatre Services, TMH
Introduction :
A new collaboration has been established between the Department of physiotherapy and Department of Anesthesia & Intensive care to provide preoperative assessment, optimization and prehabilitation for high risk patients. Cardiopulmonary exercise testing (CPEX) provides comprehensive data that reflect dynamic physiological status of patients which predicts postoperative morbidity and mortality effectively. With the introduction of CPEX service, it enhances the preoperative triage of patients to receive optimized perioperative care.
Objectives :
To provide an objective risk stratification to minimize risks of post-operative complications
Methodology :
The service was implemented in three phases.
Phase I – Acknowledgement phase
The Cardiopulmonary and Exercise Physiology Laboratory in The Hong Kong Polytechnic University was equipped with state-of-art CPEX machines. Site visit was done in 2018 where expert opinion on setting up of CPEX service was hared. After site visit, the team were sent to overseas training to equip the CPEX knowledge. The training provided by the international Perioperative and Exercise Testing & Training Society included training on CPEX operation, interpretation of CPEX data and pre-operative risk stratification. By 2019, 4 anesthetists, 2 physiotherapists and 2 nurses have completed the training.
Phase II – Trial and preparation phase
The team had carried out CPEX trials on healthy subjects to familiarize with the workflow, protocol and risk management measures. From December 2018 to August 2019, 25 CPEX trials were performed. Regular meetings were held between physiotherapists and anesthetists to optimize the workflow and to stream line the safety standard of the CPEX. Guideline, factsheet and consent form were established.
Phase III – Implementation phase
CPEX service was commenced in October 2019. The service first targeted to patients with low cardiopulmonary risks. With accumulated experience, the service extended to patients with higher risks. Physiotherapists work seamlessly with anesthetists and nurses to perform the CPEX procedure and interpret the CPEX data. Collaborative decision is made for risk stratification and appropriate care for the patients.
Result & Outcome :
From Oct 2019 to Dec 2020, 125 patients had completed CPEX. 6 of them were recommended for non-surgical treatment. 10 patients were arranged intensive prehabilitation.
Conclusion
CPEX provides an objective assessment on surgical risk stratification. Data would be collected in future to evaluate its role in enhancing post-operative outcomes.
