Clinical practice guideline: evidence, recommendations and algorithm for the preoperative optimization of anemia, hyperglycemia and smoking

Abstract

Clinical practice guideline: evidence, recommendations and algorithm for the preoperative optimization of anemia, hyperglycemia and smoking F or most of the 20th century, the focus of research in surgery was improvements in intraoperative technique, which led to major technical paradigm shifts exemplified by the evolution of transurethral resection of the prostate, 1 laparoscopic cholecystectomy, 2 endovascular aneurysm repair 3 and total mesorectal excision for rectal cancer, 4 among many others. The late 1990s and early 2000s marked a shift in surgical research toward the evidencebased management of patients in the perioperative period, beginning with the Enhanced Recovery After Surgery Group's systematic review of patients undergoing colorectal surgery. 5 That publication introduced a new paradigm focused on the impact that standardized perioperative care could have on patient outcomes such as length of stay, postoperative pain and overall complication rates. 6,7 Although a large body of literature now exists to help guide the intraoperative and perioperative management of surgical patients, our working group believes that the preoperative period, which we define as the 8 weeks

Positive Patient Postoperative Outcomes with Pharmacotherapy: A Narrative Review including Perioperative-Specialty Pharmacist Interviews

“…In addition, recent, current, or chronic use of any of the following medications and substances increases the likelihood of an adverse outcome in any patient during the perioperative period, including corticosteroids, opioids, insulin, anticoagulants, proton pump inhibitors, cancer chemotherapy, immunomodulators, ethanol, tobacco, and illicit substances [ 20 ]. Institutions have implemented DTP-related process and practice changes at key times in the admission process, that is, six to eight weeks preoperatively (prehospital) to detect and manage anemia, hyperglycemia, and smoking [ 21 ], in the preadmission clinic [ 22 , 23 , 24 ], on admission during medication reconciliation [ 25 , 26 , 27 , 28 ], throughout hospital stay [ 29 , 30 ], and at discharge [ 31 , 32 ]. In addition, theater and ward-based activities to rationalize drug therapy [ 33 , 34 ] include identifying and avoiding or minimizing the use of potentially inappropriate medications for at-risk patient populations: (1) the American Geriatric Society’s (AGS) Beers list for older adults [ 35 ]; and (2) the KIDs list for children created by the Pediatric Pharmacy Association (PPA) [ 36 ].…”

Intravenous Iron Preparations for Patients Undergoing Elective Surgery: A 2022 Update

“…One evidence-based guideline 32 was identified that presented recommendations that were broader in scope than this report; however, recommendations related to the management of pre-operative anemia were presented. Recommendations were developed by 2 reviewers based on a systematic review of evidence.…”

“…Six SRs [16][17][18][19][20][21] including 3 with meta-analysis (MA), 16,17,19 4 RCTs, [22][23][24][25] 6 non-randomized studies, [26][27][28][29][30][31] and 1 evidence-based guideline 32 was included in this report.…”

Modernizing Total Hip Arthroplasty Perioperative Pathways: The Implementation of ERAS-Outpatient Protocol

“…The preoperative period provides a unique opportunity to optimize all modifiable risk factors. Both nursing and medical evaluations should identify and address patient habits (such as smoking and excessive alcohol consumption) and comorbidities, such as ischemic heart disease, high blood pressure, sleep apnea, and malnourishment [ 14 , 15 , 16 ].…”