Tag Archive: study tool

A frequent question in the outpatient setting is whether or not a patient is optimized for surgery. There are a number of things that a physician must check in order to properly send a patient back to a surgeon with a gold star. I recently used the Johns Hopkins Internet Learning Center (HopkinsILC) to study the basic pre-operative evaluation and I highly recommend it (requires access from your school or hospital, many hospitals have access, ask your librarian).  There is a great review pdf available from HopkinsILC which details some of the highlights of the lesson.  Below I will summarize some points from the pdf. To learn more, you should ask for access to HopkinsILC, it is a great resource.

1. If the patient has any active cardiac issues, surgery should be postponed.  This includes…
1. Recent myocardial infarction (<30 days)
2. Active cardiac disease (unstable angina or worse)
3. An uncorrected arrhythmia
4. Severe aortic stenosis

2. The patient must be able to complete 4 or more ‘metabolic equivalents of task’ (METS).  This includes
1. Climbing a flight of stairs
2. Walk for 30 minutes
3. Play tennis, bowling, or other more intense sports
4. Able to vigorously clean a house (scrub floor, move furniture)

3. There are a few medications that must be stopped prior to surgery. Some examples (not an exhaustive list) include…
1. If the patient is on blood thinners (coumadin) or anti-platelet drugs (plavix, lovenox, etc) these may have to be stopped and the surgeon will have to be part of the discussion
2. Diuretics, ACE-inhibitors, and ARBS are usually held
3. Oral hypoglycemics are usually held for 1-2 days
4. Insulin is usually decreased by 50%
5. Sedatives are usually held

Again, here is the link to the pdf explaining the above points. And here is the link to the HopkinsILC website.