Perioperative Management of Parkinson’s Disease Patients: A Clinical Audit

1. Introduction

Perioperative management of Parkinson’s disease (PD) patients warrants specific additions to standard care to prevent degeneration of motor symptoms and complications caused by delayed dosing of dopaminergic medications. Barts Health have produced clinical guidelines for management of inpatients with PD; this audit assesses adherence to this guideline in the context of elective surgical admissions. 

2. Method

A database search identified patients with PD who had attended pre-operative assessment clinic (POA).  Patients were analysed separately in two groups; surgery date pre-guideline and surgery date post-guideline. This aimed to evaluate whether guideline publication had altered patient care and in which domains. In total 39 patients were identified who were within the scope of the audit (16 pre-guideline and 23 post-guideline). Data regarding demographics, pre-operative, intra-operative, and post-operative care were gathered retrospectively from the electronic patient record. 

3. Results

Pre-operatively, documentation of patient dosing schedule was low pre- and post-guideline (25% and 30.4% respectively). Baseline swallow was rarely documented (5.3%, 3.7%) and a minority of patients were first on the surgical list (42.8%, 30.4%). Encouragingly, rates of anaesthetics and Trauma and perioperative older persons service (TPOPs) review increased after guideline publication (56.3% to 65.2%, and 12.5% to 17.4%, respectively). Documentation of personalised PD care plans remained low (31.3%, 30.4%). Post-operatively, there was a significant decrease in rates of post-operative delirium from 31.3% to 4.3% (p = 0.03), however rates of missed/delayed PD medications increased from 6.25% to 26.1% (p = 0.15).

4. Conclusion(s)

We recommend introduction of a POA document for PD patients to ensure documentation of regular dosing schedule and baseline swallow. Additionally, PD patients aged ≥65 should be reviewed in TPOPs clinic, where a personalised PD plan should be generated. Further audit cycles after implementation of recommendations with further analysis into adverse outcomes including 30-day mortality and complications of swallow deterioration should follow.