For the Physician:
What is Peri-Operative
care is a new branch of Internal Medicine and includes three stages
evaluation of surgical patients by an internist for factors
affecting surgical outcome and post-operative course.
evaluation and management of the patient's medical problems along
with the surgical team during the post-operative period.
for appropriate patient follow-up with their primary care physician
for any issues that developed in the peri-operative period or
for non-urgent problems discovered in the course of peri-operative
internist coordinates closely in their consulting role with both the
surgeon and the patient's primary care physician.
from Peri-Operative Evaluation?
care can positively impact patient outcomes. One British study of 200
patients showed patients who answered yes to any of the questions on
a peri-operative quesionnaire benefited in outcome or length-of-stay
measures if they underwent peri-operative evaluation. Many other studies
demonstrated improved lengths-of-stay in co-managed (medicine and surgery)
traditionally, pre-operative evaluation has focused on cardiac risk
factors alone, in this new field, attention is also given to several
different factors affecting surgical outcome. These include:
traditional evaluation of Cardiac Risk using several published
criteria including AHA/Eagle and Deitske (Modified Goldman)
Criteria. Further risk stratification, if warranted, is done
prior to surgery and a plan for prevention and management of
potential cardiac risk is made pre-operatively.
of risk factors for DVT-both those specific to the patient and
those specific to the surgery. A recommendation is made for
appropriate post-operative DVT prophylaxis.
of the patient's medications, including alternative or herbal
medications, is undertaken to identify those which may affect
anesthesia or alter operative outcome by changing the risk of
inter-operative or post-operative hemorrhage, or in the case
of estrogen, increasing the risk of post-operative DVT.
of the patient's pulmonary risk, including the risk of sleep
for the use of steroids in the recent past.
of the patient's past surgical history and any specific complications
related to surgery including malignant hypothermia, confusion,
post-operative hemorrhage or DVT.
of the possibility of previously unidentified pregnancy in women.
with added questions addressing peri-operative issues.
of social history for risk factors associated with increased peri-operative
risk such as smoking, drug use or excessive alcohol use.
chronic medical problems for their optimization prior to surgery.
of the specific medical risks associated with surgery with the
patient. The ultimate decision to proceed to surgery, however,
is between the patient and the surgeon.
(Please note the questionnaire
is to be completed by your patient upon referral. This questionnaire
is available in the Patient
Forms section of the website.)