Optimizing postoperative outcomes with efficient preoperative assessment and management

Abstract

The major shift in preoperative assessment and management from within the hospital to outside the hospital has prompted new efforts to coordinate preoperative care. Much of this can be accomplished with the introduction of a preadmission testing center. Under the direction of a physician (typically an anesthesiologist), the Pre-Admission Testing Center staff performs necessary assessments and coordinates necessary information about the presurgical patient. This assessment should include features essential to the general history and physical examination, as well as the specific issues related to anesthesia and surgery. The preoperative visit is also an opportunity to perform directed laboratory testing (as opposed to across the board batteries of tests) and to carefully plan out the continuance, discontinuance, or initiation of medications in the perioperative period. It also may be beneficial to stabilize disorders such as hypertension and, when indicated, initiate preoperative optimization of patients with advanced disease. The ultimate goal is to provide safe and "efficient" care, without exhausting highly valued intensive care resources.

Guidelines for Perioperative Care for Pancreaticoduodenectomy: Enhanced Recovery After Surgery (ERAS®) Society Recommendations

“…Preoperative counselling targeting expectations about surgical and anaesthetic procedures may diminish fear and anxiety and enhance postoperative recovery and discharge [13][14][15]. Personal counselling, leaflets or multimedia information containing explanations of the procedure along with tasks that the patient should be encouraged to fulfil may improve perioperative feeding, early postoperative mobilisation, pain control, and respiratory physiotherapy; and hence reduce the risk of complications [16][17][18].…”

Drug-Related Problems in Patients Undergoing Elective Total Joint Arthroplasty of the Hip or Knee

“…6 Optimization of a patient's medication therapy is one area where postoperative outcomes can be improved through preoperative assessment and management. 7 It has been well established that the clinical activities of pharmacists improve patient care in the surgical setting [1][2][3][4][5] and other patient care areas, 8 which could include preadmission and prehabilitation.…”

Perioperative processes and outcomes after implementation of a hospitalist‐run preoperative clinic

“…Evidence-based protocols were developed to standardize the evaluation. Examples of guidelines include: laboratory and radiological testing guidelines, [6][7][8][9][10] initiation of perioperative beta blockers, 11 selection criteria for pulmonary function tests, 12 protocols for ''bridging'' with low-molecular-weight heparin for patients on oral vitamin K antagonists, 13 the cardiovascular evaluation based on American College of Cardiology/American Heart Association (ACC/AHA) guidelines, 14 as well as adjustment of diabetic medications.…”