Guidelines

Guidelines

In this section you'll find guidance developed by CPOC or guidance CPOC has produced in collaboration with other organisations.
 

CPOC produces guidance as an aid to support health care professionals in perioperative care. We use robust processes to develop our guidance taking into consideration expert opinion and the latest research.

CPOC develops its own guidance under the six strategic themes laid out in the CPOC Strategy 2020-2023. In this section you can view all the guidance CPOC has published or currently working on. CPOC aims to provide a bank of resources on all things perioperative care.

We regularly review our guidance on this website.

CPOCPerioperativePathway

Our CPOC guidelines encompass the whole perioperative pathway and include recommendations for each distinct area across the perioperative journey. 

 

CPOC Guidelines

Guidelines

SARS-CoV-2 infection,COVID-19 and timing of elective surgery 

A multidisciplinary consensus statement on behalf of the Association of Anaesthetists, the Centre for Perioperative Care, the Federation of Surgical Specialty Associations, the Royal College of Anaesthetists and the Royal College of Surgeons of England.

The scale of the COVID-19 pandemic means that a significant number of patients who have previously been infected with SARS-CoV-2 will require surgery. Given the potential for multisystem involvement, timing of surgery needs to be carefully considered to plan for safe surgery. This consensus statement uses evidence from a systematic review and expert opinion to highlight key principles in the timing of surgery. Shared decision-making regarding timing of surgery after SARS-CoV-2 infection must account for severity of the initial infection; ongoing symptoms of COVID-19; comorbid and functional status; clinical priority and risk of disease progression; and complexity of surgery. For the protection of staff, other patients and the public, planned surgery should not be considered during the period that a patient may be infectious. Precautions should be undertaken to prevent pre- and peri-operative infection, especially in higher risk patients. 


Elective surgery should not be scheduled within 7 weeks of a diagnosis of SARS-CoV2 infection unless the risks of deferring surgery outweigh the risk of postoperative morbidity or mortality associated with COVID-19. SARS-CoV-2 causes either transient or asymptomatic disease for most patients, who require no additional precautions beyond a 7-week delay, but those who have persistent symptoms or have been hospitalised require special attention. Patients with persistent symptoms of COVID-19 are at increased risk of postoperative morbidity and mortality even after 7 weeks. 


The time before surgery should be used for functional assessment, prehabilitation and multidisciplinary optimisation. Vaccination several weeks before surgery will reduce risk to patients and might lessen the risk of nosocomial SARSCoV-2 infection of other patients and staff. National vaccine committees should consider whether such patients can be prioritised for vaccination. 


As further data emerge, these recommendations may need to be revised, but the principles presented should be considered to ensure safety of patients, the public and staff.

Read the full guideline here

Perioperative Care for the Cystic Fibrosis Patient

Cardiff and Vale University Health Board

The guidance aims to provide a background knowledge of Cystic Fibrosis [CF] for the anaesthetist and give guidance and best practice for the perioperative anaesthetic management of the patient with CF presenting for surgery.

CF affects multiple organ systems. However, the impact of CF on the respiratory and gastrointestinal systems account for the majority of morbidity and mortality. Therefore CF patients are generally considered a high risk group for anaesthesia, particularly given their potential for postoperative respiratory complications.

Please read a full copy of the guidance here

Guidelines for the Provision of Anaesthetic Services (GPAS)

The Guidelines for the Provision of Anaesthetic Services (GPAS) support anaesthetists with responsibilities for service delivery and healthcare managers to design and deliver high quality anaesthetic services. It is developed using a rigorous, evidence-based process, which was accredited by the National Institute for Health and Care Excellence (NICE) in 2016.

Each of the GPAS chapters should be seen as independent but interlinked documents. Guidelines on the general provision of anaesthetic services are detailed in the following chapters of GPAS:

  • chapter 2: guidelines for the provision of anaesthesia services for preoperative assessment and preparation
  • chapter 3: guidelines for the provision of anaesthesia services for intraoperative care
  • chapter 4: guidelines for the provision of anaesthesia services for postoperative care

These guidelines apply to all patients who require anaesthesia or sedation, and are under the care of an anaesthetist. For urgent or immediate emergency interventions, this guidance may need to be modified as described in chapter 5: guidelines for the provision of emergency anaesthesia.

Click here to read the full GPAS guidelines.

Prehabilitation for people with cancer

Principles and guidance for prehabilitation within the management and support of people with cancer

In partnership with Macmillan Cancer Support, The Royal College of Anaesthetists (RCoA) and the National Institute for Health Research (NIHR) Cancer & Nutrition Collaboration

Macmillan Cancer Support, the RCoA and the NIHR Cancer and Nutrition Collaboration in July 2019 launched a report calling for changes to the delivery of cancer care across the UK, with a greater focus on prehabilitation including nutrition, physical activity and psychological support.

Seventy per cent of the 1.8 million people in the UK living with cancer are also living with one or more other long-term health conditions. The guidance report, Prehabilitation for people with cancer, promotes evidence that when services are redesigned so that prehabilitation is integrated into the cancer pathway:

  • patients feel empowered and quality of life is improved
  • physical and psychological resilience to cancer treatments is maximised
  • long-term health is improved.

Teams from Macmillan Cancer Support, RCoA and NIHR have worked together to develop these principles and guidance together with an action plan. This sets out how NHS organisations across the UK can replicate some of the pioneering work already taking place at a limited number of Trusts – all of which have demonstrated how prehabilitation has improved outcomes and reduced the risk of disease progression.

Access the guidance report here

A review of the perioperative care of surgical patients

This report, released by NCEPOD in 2011, recommends that:

  • There is a need to introduce a UK wide system that allows rapid and easy identification of patients who are at high risk of postoperative mortality and morbidity. (Departments of Health in England, Wales & Northern Ireland)
  • All elective high risk patients should be seen and fully investigated in pre-assessment clinics. Arrangements should be in place to ensure more urgent surgical patients have the same robust work up. (Clinical Directors and Consultants)
  • An assessment of mortality risk should be made explicit to the patient and recorded clearly on the consent form and in the medical record. (Consultants)
  • The postoperative care of the high risk surgical patient needs to be improved. Each Trust must make provision for sufficient critical care beds or pathways of care to provide appropriate support in the postoperative period. (Medical Directors).
  • To aid planning for provision of facilities for high risk patients, each Trust should analyse the volume of work considered to be high risk and quantify the critical care requirements of this cohort. This assessment and plan should be reported to the Trust Board on an annual basis. (Medical Directors) Principal Recommendations T

Click here to read the document in full.

NICE guidelines on routine preoperative tests for elective surgery

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available.

When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service.

It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.

Click here to read the guidelines in full.

Being Active: An everyday guide for people living with an impairment or health condition

This guide, produced by the English Federation of Disability Sport, Disability Rights UK and Sport England, seeks to provide the information needed to support people living with a disability or health condition to become more active.

While the guide does not discuss the issues around every impairment or sport, it provides broadly applicable advice for people who wish to become more active and overcome the barriers that may be preventing them from doing so.

If you would like further information on the issues discussed in the guide, you can find out more by visiting the Activity Alliance website.

If you have any ideas for future CPOC guidelines, please view our guideline proposal page.

CPOC Endorsement & Support 

If you are interested in obtaining CPOC endorsement or support for your resource please read our policy and get in touch to discuss things further.