70 y/o M with recurrent gallstone pancreatitis. Several other episodes this year, not requiring hospitalisation.

Background:

• OSA- occasional CPAP compliance
• NYHA- Class III for breathlessness. TTE – nil significant issues detected.
• BMI 40
• ESRF- haemodialysis 3 times a week 
  • 500ml fluid restriction (oliguric)
  • Secondary chronic anaemia, using an ESA + Fe
• R) nephrectomy 2022 – postoperative ICU admission for vasopressor support and hyperkalemia management
• 4WW, mobility scooter for longer distances. Reduced exercise tolerance since ICU admission.

Issues:

• Functional decline
• Multimorbidity

Discussion:

• Perioperative risks: NSQUIP: 6.4% serious, 0.8% risk of death, 26 % functional decline 
• Conservative management carries significant risks with recurrent episodes of gallstone pancreatitis
• Patient motivated for pre-habilitation 

Plan:

• Pre-habilitation 6 weeks
• Dietitian review ongoing (BMI ) through dialysis