Outcomes and Processes of Care Related to Preoperative Medical Consultation

Wijeysundera, Duminda N.

doi:10.1001/archinternmed.2010.204

Cited by 81 publications

(79 citation statements)

References 38 publications

(28 reference statements)

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“…Previous studies, although in preoperative patients, suggest that cardiac testing in a low-risk population may actually have increased morbidity. [23][24][25] The derivation of a postoperative cardiac screening algorithm should also consider that commercially available postoperative electrocardiogram (ECG) monitoring lacks the necessary sensitivity owing to the preexisting ST-T wave changes, both left and right bundle branch blocks, and atrial fibrillation, abnormalities that pre-exist in [ 30% of moderate-risk surgical populations. 26 Perioperative medications and electrolyte imbalances also interfere with interpretation of the ST segments.…”

Section: Discussionmentioning

confidence: 99%

Use of clinically based troponin underestimates the cardiac injury in non-cardiac surgery: a single-centre cohort study in 51,701 consecutive patients

Beattie

Karkouti

Tait

et al. 2012

Can J Anesth/J Can Anesth

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Section: Discussionmentioning

confidence: 99%

Use of clinically based troponin underestimates the cardiac injury in non-cardiac surgery: a single-centre cohort study in 51,701 consecutive patients

Beattie

Karkouti

Tait

et al. 2012

Can J Anesth/J Can Anesth

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“…Although this study used a matched cohort, the unmatched cohort that underwent consultation was higher risk; also, selection bias was possible, as the reasons for initial consultation were unknown. 5 Historically, the Preoperative clinic at VA Greater Los Angeles Healthcare System (VAGLAHS) was supervised by the Department of Anesthesiology. In July 2004, the Preoperative clinic was restructured with Hospitalist oversight.…”

Section: Discussionmentioning

confidence: 99%

Perioperative processes and outcomes after implementation of a hospitalist‐run preoperative clinic

Vazirani

Lankarani‐Fard

Liang³

et al. 2012

Journal of Hospital Medicine

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BACKGROUND:A structured, medical preoperative evaluation may positively impact the perioperative course of medically complex patients. Hospitalists are in a unique position to assist in preoperative evaluations, given their expertise with inpatient medicine and postoperative surgical consultation.OBJECTIVE:To evaluate specific outcomes after addition of a Hospitalist‐run, medical Preoperative clinic to the standard Anesthesia preoperative evaluation.DESIGN, SETTING, PATIENTS:A pre/post retrospective, comparative review of outcomes of 5223 noncardiac surgical patients at a tertiary care Veterans Administration (VA) medical center.RESULTS:Length of stay was reduced for inpatients with an American Society of Anesthesia (ASA) score of 3 or higher (P < 0.0001). There was a trend towards a reduction in same‐day, medically avoidable surgical cancellations (8.5% vs 4.9%, P = 0.065). More perioperative beta blockers were used (P < 0.0001) and more stress tests were ordered (P = 0.012). Inpatient mortality rates were reduced (1.27% vs 0.36%, P = 0.0158).CONCLUSION:A structured medical preoperative evaluation may benefit medically complex patients and improve perioperative processes and outcomes. Journal of Hospital Medicine 2012. © 2012 Society of Hospital Medicine

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“…To avoid incomplete medication records, we excluded participants without at least 1 year of eligibility for prescription drug coverage through the Ontario Drug Benefit. Fourteen prespecified major noncardiac surgeries were included: abdominal aortic aneurysm repair, carotid endarterectomy, peripheral vascular surgery, femur and hip surgery, knee replacement, lung resection, gastrectomy or esophagectomy, bowel and rectal surgery, liver resection, pancreaticoduodenectomy, abdominal hysterectomy, radical prostatectomy, nephrectomy, and cystectomy 9, 10. In the event of multiple surgeries performed during the study period, only the first qualifying surgery was used as the index procedure.…”

Section: Methodsmentioning

confidence: 99%

Association of Atrial Fibrillation and Oral Anticoagulant Use With Perioperative Outcomes After Major Noncardiac Surgery

Atzema

et al. 2017

JAHA

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BackgroundWe examined the association of atrial fibrillation (AF) and oral anticoagulant use with perioperative death and bleeding among patients undergoing major noncardiac surgery.Methods and ResultsA population‐based study of patients aged 66 years and older who underwent elective (n=87 257) or urgent (n=35 930) noncardiac surgery in Ontario, Canada (April 2012 to March 2015) was performed. Outcomes were compared between AF groups using inverse probability of treatment weighting using the propensity score. Of 4612 urgent surgical patients with AF, treatments before surgery included warfarin (n=1619), a direct oral anticoagulant (DOAC) (n=729), and no anticoagulation (n=2264). After urgent surgery, the death rate within 30 days was significantly higher in patients with AF compared with patients with no AF (hazard ratio [HR], 1.28; 95% confidence interval [CI], 1.12–1.45). In contrast, among 4769 elective surgical patients with AF treated with warfarin (n=1453), a DOAC (n=1165), or no anticoagulation (n=2151), prior AF was not associated with higher mortality. Comparing patients with AF who were or were not anticoagulated, there was no difference in 30‐day mortality after urgent (HR, 0.95; 95% CI, 0.79–1.14) or elective (HR, 0.65; 95% CI, 0.38–1.09) surgery. There was no difference in 30‐day mortality between patients with AF treated with a DOAC or warfarin after urgent (HR, 0.91; 95% CI, 0.70–1.18) or elective (HR, 1.64; 95% CI, 0.77–3.53) surgery. Bleeding and thromboembolic rates did not differ significantly among patients with AF prescribed a DOAC or warfarin.ConclusionsPrior AF was associated with 30‐day mortality among patients undergoing urgent surgery. In patients with AF, neither the preoperative use of oral anticoagulants, nor the type of agent (either a DOAC or warfarin) were associated with the rate of 30‐day mortality.

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Outcomes and Processes of Care Related to Preoperative Medical Consultation

Cited by 81 publications

References 38 publications

Use of clinically based troponin underestimates the cardiac injury in non-cardiac surgery: a single-centre cohort study in 51,701 consecutive patients

Use of clinically based troponin underestimates the cardiac injury in non-cardiac surgery: a single-centre cohort study in 51,701 consecutive patients

Perioperative processes and outcomes after implementation of a hospitalist‐run preoperative clinic

Association of Atrial Fibrillation and Oral Anticoagulant Use With Perioperative Outcomes After Major Noncardiac Surgery

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