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.
- If the patient has any active cardiac issues, surgery should be postponed. This includes…
- Recent myocardial infarction (<30 days)
- Active cardiac disease (unstable angina or worse)
- An uncorrected arrhythmia
- Severe aortic stenosis
- The patient must be able to complete 4 or more ‘metabolic equivalents of task’ (METS). This includes
- Climbing a flight of stairs
- Walk for 30 minutes
- Play tennis, bowling, or other more intense sports
- Able to vigorously clean a house (scrub floor, move furniture)
- There are a few medications that must be stopped prior to surgery. Some examples (not an exhaustive list) include…
- 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
- Diuretics, ACE-inhibitors, and ARBS are usually held
- Oral hypoglycemics are usually held for 1-2 days
- Insulin is usually decreased by 50%
- 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.
My name is Andrew and I am a first year resident training to be an ophthalmologist. I created ShortWhiteCoats to provide medical students, residents, and the public with all the information I spent so many hours looking for during medical school.
