70s male, for neck dissection + tracheostomy. 

Background

• AF – rate controlled 
• High BMI 36 – undergoing intentional weight loss and physical activity regimen
• HTN 
• Ex smoker 
• T2DM 
• ?OSA – high STOPBANG score 

Issues

• Extensive surgery for a frail patient
• Patient understanding of treatment options and extent of surgery (unaware of tracheostomy component) – patient wanting to explore non-surgical options

Discussion

• Multiple comorbidities however patient self-motivated and already improving their fitness/health independently
• Extensive surgery but physiologically moderate stress due to peripheral nature
• OSA not needing optimization prior to this procedure. Nil other optimizable comorbidities identified.

Plan

• Referral to surgeons for further discussions with patient
• Suitable to proceed to surgery should that be the final plan
• Advanced care planning – booklet provided to patient