Current UK practice of pre-operative risk assessment prior to neurosurgery

Background: Intra-cranial and spinal surgery is associated with significant morbidity (23.6% and 11.2%) (5) . Fully informed consent, shared decision-making and optimal peri-operative care are essential to ensure excellent surgical outcome. There is evidence to support the use of formal pre-operative risk assessment to facilitate this in non-cardiac surgery but little is published on best practice for neurosurgery. Our aim was to establish current practice in pre-operative risk assessment at UK Neurosciences centres.

Methods: A national peer-reviewed electronic structured survey on current practice of pre-operative risk assessment was conducted through the Neuroanaesthesia Society of Great Britain and Ireland or NASGBI in 2014.

Results: We received a response from every UK neurosciences centre. 85% of neurosurgical units offer pre-operative assessment or PAC for elective admissions with 32% of respondents performing formal risk assessment. The Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM) and its Portsmouth (P-POSSUM) modification were used most frequently. Although formal multi-disciplinary team discussions were conducted rarely following risk assessment, the results guided post-operative care and were used for consent.

Conclusions: Our survey is the first of its kind in the UK for neurosciences. As expected, formal risk assessment and multi-disciplinary team discussion is not routine. Neurosurgery has a high risk of morbidity and mortality, and pre-operative risk assessment should therefore be considered in line with national recommendations. Further work is required to establish best practice in neurosurgery to ensure that patients are appropriately consented, and to improve standards of care and support surgical outcome data.