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.