Address:

Office Hours:
Office hours are by appointment.

Wednesday:
extended hours
Noon to 8 p.m.

Telephone:
(360) 226 - 3672

Fax:
(360) 226 - 3680

 


Peri-Operative Care

For the Physician:

What is Peri-Operative Care?

Peri-operative care is a new branch of Internal Medicine and includes three stages

1.

Pre-operative evaluation of surgical patients by an internist for factors affecting surgical outcome and post-operative course.

2. Continued evaluation and management of the patient's medical problems along with the surgical team during the post-operative period.

3. Arranging 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 testing.

The peri-operative internist coordinates closely in their consulting role with both the surgeon and the patient's primary care physician.

Who Benefits from Peri-Operative Evaluation?

Peri-operative 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) patients.

While 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:

1.

The 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.

2.

The evaluation 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.

3.

An evaluation 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.

4.

An evaluation of the patient's pulmonary risk, including the risk of sleep apnea.

5. An evaluation for the use of steroids in the recent past.

6. A survey of the patient's past surgical history and any specific complications related to surgery including malignant hypothermia, confusion, post-operative hemorrhage or DVT.

7. Assessment of the possibility of previously unidentified pregnancy in women.

8. Family history with added questions addressing peri-operative issues.

9. Drug allergy reviews.

10. Evaluation of social history for risk factors associated with increased peri-operative risk such as smoking, drug use or excessive alcohol use.

11. Review of chronic medical problems for their optimization prior to surgery.

12. Discussion 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.)

All content, unless noted
� 2004, Emitis Hosoda