Rethinking preop testing



Dr. Steven Cohn of the University of Miami

Dr. Steven Cohn

Steven Cohn, MD, SFHM, director of the medical consultation service at Jackson Memorial Hospital in Miami, reviewed cardiac risk assessment in noncardiac procedures. He cautioned that the Revised Cardiac Risk Assessment was created based on patients with lengths of stay of at least 2 days and shouldn’t be used for low-risk or ambulatory procedures because it will overestimate the risk.

Dr. Cohn’s philosophy is to not suggest a delay without firm evidence that it is necessary. “I try not to interfere with surgery unless I feel that there is significant risk,” he said.

Kurt Pfeifer, MD, professor of internal medicine at the Medical College of Wisconsin, Milwaukee, said general risk factors for preoperative pulmonary complications include functional dependence, prolonged surgery or surgery close to the respiratory tree, older age, and multiple comorbidities. Dr. Pfeifer recommended using lung expansion for high-risk patients, screening for obstructive sleep apnea with the STOP-BANG questionnaire, and identifying potentially difficult airways well in advance of a procedure.

In workshop discussions at the HM18 pre-course, hospitalists considered their contributions to preoperative care and ways they might be able to contribute more effectively. Among their ideas were better communication with anesthesiology – regarded as severely lacking by many hospitalists in the session – as well as designating smaller perioperative teams to foster knowledge and greater trust with surgeons.


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