‘Surgical pause’ saving lives, expanding beyond VA hospitals

Editor's Note

The “surgical pause”—a means of validating whether surgery is truly safe for patients deemed to be “frail” before starting a procedure—significantly reduces mortality rates and is changing practices at more than 50 Veterans Administration (VA) hospitals, the Pittsburgh Post-Gazette reported August 18.

Developed by VA surgeons Daniel Hall and Jason Johanning, the surgical pause is a brief evaluation using Risk Analysis Index (RAI, a tool developed for nursing homes) to determine a patient's frailty level before surgery, the outlet reports. If a patient is identified as frail—a determination linked to more than just age— a detailed discussion between the surgeon and patient follows, focusing on the risks and benefits of surgery in relation to the patient's personal goals.

At the Omaha VA Medical Center, the implementation of this procedure decreased post-surgical mortality from 25% to 8% among frail patients, the outlet reports. This and other successes have led to the method’s adoption in than 50 VA hospitals and several civilian institutions across the U.S. and internationally.

The article focuses particularly on the experience of the University of Pittsburgh Medical Center. Sources include Benjamin Reynolds, UPMC’s Chief Advanced Practice Officer, who emphasized that the Surgical Pause allows for better-tailored care, reducing the risk of postoperative complications and mortality, which can be up to four times higher in frail patients.

The report emphasizes Hall’s view that there is no such thing as low-risk surgery for frail patients. The Surgical Pause ensures that patient care is tailored to their specific needs, potentially leading to better outcomes and lower mortality rates. Additionally, the procedure often results in some patients opting for non-surgical management, which may include "prehabilitation" exercises that improve their overall fitness before any surgery, further enhancing recovery and outcomes.