Ch.6 - Pre-op Assessment

Question 1

Labs from how far before the surgery can be used reliably?

For all pts > 65yo which lab is recommended?

For all pts > 50yo what should be checked?

Answer 1

4mo.

Hgb for >65

Cr for >50

Question 2

When to order ekg pre-op?

Answer 2

For pts with known heart disease, PAD, or cerebrovascular disease

Question 3

When to order cxr pre-op?

Answer 3

For pts with known cardiopulmonary disease or

> 50yo who needs major abdominal surgery

BMI > 40

Question 4

What’s the evidence behind bowel prep?

If your institution is selective about bowel prep before surgery what would be some of the indications?

Answer 4

Cochrane review of 5800 pts said no difference

But the Jung study looking at 1300 pts, randomized prospective, said long term outcomes are better?

1) if the pt is planned to be diverted for left and rectal resections
2) when an intracorporeal anastomosis is planned
3) require intraoperative colonoscopy

Question 5

Perioperative abx. How much risk reduction for SSI?

What’s the ideal regimen (timing if when to give abx)

Answer 5

Risk reduction of 75%. Decrease in wound infection from 40% to 6-14%

Abx with bowel prep 24hr before the surgery
Abx 1hr prior to surgery in the OR
No benefit, giving abx beyond 24 hr

Question 6

What is the evidence behind alvimopan?

What’s the mechanism of action?

Answer 6

Peripheral acting mu-receptor blocker.

Decreased the rate of post-op ileus (12% vs 4%)

Length of stay and readmission rate was the same

Question 7

What is the evidence behind chewing gum?

Answer 7

Robust. Decreased LOS. Decreased time to return bowel function