Polymorbidity, patellar hardware removal

78yo male with patella ORIF in 2020 after MVA. Hardware now painful, for removal.

Background:

  • Significant respiratory disease
    • FEV1 30%, FVC 70%
    • Recent respiratory physician review – ‘as good as he gets’
  • IHD – further details unclear. ECG normal
  • Upper airway cancer – treated with radiotherapy.
  • Bladder tumour – local radiotherapy, quiescent
  • Post-traumatic epilepsy after fall from horse decades ago.
  • Distant PE
  • METS 3
  • Iron deficiency anaemia
  • Frail

Issues and discussion

  • Should surgery proceed
    • Reasonable indication for surgery
    • Uneventful surgical episode last year, reassuring
  • Optimisation of lungs possible?
    • ARISCAT score = low risk (0.9%) for postoperative pulmonary complications
    • Given he has been reviewed by the respiratory physician recently, nil further optimisation felt possible.
  • Anaesthetic technique?
    • Patient amenable to spinal anaesthetic. Good option.

Plan and Requested Actions:

  • Proceed to OT.
  • Normal ward-based care assuming nil complications intraop.