Perioperative care after thoracoabdominal aortic aneurysm repair: The Baylor College of Medicine experience. Part 1: Preoperative considerations

Abstract

The Texas Medical Center has been home to pioneering aortic surgeons Michael E. DeBakey, Denton A. Cooley, and E. Stanley Crawford, on whose legacies modern thoracoabdominal aortic surgery has been built. During the past 3 decades, our single-center practice (led by J.S.C.) has performed more than 3600 open thoracoabdominal aortic aneurysm repairs (TAAARs), including the largest published series to date (N ¼ 3309). 1 Continuing to refine the perioperative management of TAAAR patients is critical. In this 2-part series, we discuss the current practice at Baylor College of Medicine/CHI Baylor St Luke's Medical Center in Houston, Texas. Part 1 of this report focuses on unique preoperative considerations to reduce the risk of adverse operative outcomes. Part 2 focuses on postoperative management to reduce the risk of complications and to manage those that arise. Although other experienced centers may have different approaches to common conditions and produce good surgical outcomes, we provide this guide as a foundation for surgeons, intensivists, trainees, advanced practice providers, nurses, and others involved in the multidisciplinary management of these complex surgical patients. PREOPERATIVE CONSIDERATIONSWe have described our approach to preoperative planning in detail. 2 Briefly, we assess age and physiologic reserve, stratify risk, stop antiplatelet and anticoagulant medications, advise tobacco cessation, and optimize major neurologic, cardiovascular, respiratory, and renal comorbidities. 3 The major surgical risks include mortality, paraplegia, renal failure, stroke, respiratory failure, and myocardial infarction. Each of these risks is discussed with the patient and family. Surgical timing is influenced by aneurysm size and growth rate; presence of leak, rupture, or acute dissection; and symptomatology (Table 1). 2

The impact of preoperative interview and prospective nursing on perioperative psychological stress and postoperative complications in patients undergoing TACE intervention for hepatocellular carcinoma

“…This is because preoperative nursing visits combined with anticipatory nursing conduct a comprehensive evaluation of the patient understanding and the progression of their illness before surgery which helps patients to understand and prepare for the surgery, and can also raise relevant questions about the surgery. [ 21 , 22 ] Meanwhile, nursing staff can explain the surgical process, risks, and expected outcomes to patients in detail based on the patients’ cognitive level. This increases patients’ understanding and knowledge of the disease and can improve their acceptance of the surgery.…”

Current approaches to spinal cord protection during open thoracoabdominal aortic aneurysm repair

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Perioperative management of patients undergoing thoracic endovascular repair

“…Individualized preoperative cardiovascular risk assessment is performed in elective settings consistent with current guidelines (2) focusing on age and physiological reserve, risk stratification, antiplatelet and anticoagulant medication cessation, tobacco cessation if necessary and optimization of major neurological, cardiovascular, respiratory and renal comorbidities, to reduce modifiable risks. Major preoperative comorbidities should be evaluated according to acuity of presentation and clinical indication for TEVAR (3).…”