Authors: (including presenting author): :
Sze CM(1), Lee MY(1), Wong YH(1), Wong MN(1), Yip WM (1), Chan K(2)
Affiliation: :
(1) Department of Anaesthesiology, Pain Medicine and Operating Services, United Christian Hospital (2)School of Nursing, The Hong Kong Polytechnic University
Keyword 1: :
hypertension
Keyword 2: :
pre-operative
Keyword 3: :
blood pressure
Keyword 4: :
optimization
Keyword 5: :
day surgery centre
Introduction: :
Hypertension is highly prevalent in Hong Kong, and uncontrolled blood pressure before surgery can result in postponement or cancellation of procedures, leading to treatment delays, patient dissatisfaction, and increased healthcare costs. Data from 2024 showed that 17 operations were cancelled due to poorly controlled hypertension, accounting for 0.23% of overall cancellations in the day surgery centre.
Objectives: :
A new pre-operative program is introduced and aims to reduce surgery cancellations related to poorly controlled hypertension by improving patient flow before the pre-anaesthetic assessment clinic.
Methodology: :
The program objectives will be achieved through early detection and intervention, development of a structured patient education program, and coordination of referral resources to expedite hypertension management, thereby supporting patients to undergo surgery successfully. A new patient flow was implemented so that all adults referred to the Pre-Anaesthetic Assessment Clinic (PAAC) received blood pressure screening at the time of appointment booking, allowing earlier optimisation opportunities. Patients with blood pressure readings above 140/90 mmHg were recruited into the program. The educational program, structured using Biggs’s 3P model, comprised three modules: (1) hypertension knowledge and home blood pressure monitoring, (2) dietary management with a low-salt diet, and (3) a physical exercise management, delivered via videos and electronic pamphlets with telenursing follow-up over 2–4 weeks. Patients with persistently uncontrolled blood pressure were referred to General Outpatient Clinic (GOPC) or the Chronic Disease Co-care Pilot Scheme (CDCC) for further management. Blood pressure monitoring, antihypertension drug compliance, adherence assessments, and a satisfaction survey were used to evaluate outcomes, and nursing staff received in-service training to support implementation.
Result & Outcome: :
From May 2025 onwards, 18 patients completed the program, with average blood pressure improving from 156/78 mmHg to 122/77 mmHg. All participants followed home blood pressure monitoring instructions, and 72% adhered to dietary and exercise guidance. Four patients were referred to the GOPC, CDCC or Accident and Emergency Department for further management. Of these, two were newly diagnosed with hypertension, and two required an increased dose of antihypertensive medication. Three patients were additionally recruited to the new nurse-led telehealth service with video-call consultations for follow-up. All participants agreed that the program help to improve their blood pressure control before surgery and expressed overall satisfaction to the program. This program successfully optimized preoperative hypertension management, enabling all participants to proceed to surgery without cancellations and complications.
