Cancellation for respiratory issues

 Distance patent for C3/4 laminectomy.

Background

  • Respiratory disease
    • Ex-smoker
    • 2015: FEV1 1.6, SpO2 91%
  • HCV + but no viral load, spontaneously cleared
  • 4WW, independent with ADLs

Events

  • Distance patient, in-person review not arranged.
  • Requested ECG from GP, spirometry on arrival
  • Patient in the anaesthetic bay at 5pm, wheezy, SpO2 84%, FEV1 1L, ECG – RBBB, no improvement with bronchodilator.
  • Surgery cancelled; patient admitted to the ward for TTE (? Cardiac contribution) and respiratory r/v. 

What can be learnt?

  • Should they have been reviewed in person?
    • Challenging times, differential lockdowns from our district to another. Risk of patients having to self-isolate for 14 days if they attend a clinic appointment.
    • Our preferences may not align with the patient’s choice. 
  • Were there red flags?
    • 91% SpO2 on RA documented 5yrs previously.
    • Would be useful to ask GP for updated set of observations. This would provide reassurance (if normal) or would prompt a review and optimization (if abnormal).
  • Who should have spirometry?
    • Evidence suggests it is indicated for:
      • The identification and characterisation of respiratory disease (obstructive and restrictive). 
      • Patients with COPD or asthma, where there is suspected deviation from best baseline. 
      • Thoracic surgery- assessment of post-operative predictive lung function.