Peri-operative management

Question 1

How many days before surgery should warfarin be ceased/bridged?

Answer 1

5

Question 2

How many days before surgery should DOACs be ceased for a low-risk procedure

Answer 2

1-2

Question 3

How many days before surgery should DOACs be ceased for a high-risk procedure?

Answer 3

2-3

Question 4

Aspirin is continued for many operations. If it needs to be stopped pre-operatively, how many days before surgery should aspirin be ceased?

Answer 4

5-7

Question 5

How many days before surgery should clopidogrel/ticagrelor etc. be ceased?

Answer 5

5-7

Question 6

All of the following can be continued on the day of surgery except one. Which is it?

• beta blocker
• CCB
• Diuretic
• ACEi
• Statin

Answer 6

ACEi. Should only be continued if indicated for CCF or poorly controlled hypertension. Otherwise, take the last pre-operative dose on the day before surgery

Question 7

Should non-statin lipid-lowering agents be taken on the day of surgery?

Answer 7

No. Take last dose on the day before surgery.

Question 8

Aside from SGLT2 inhibitors and insulin, when should all diabetic medications be ceased pre-operatively, regardless of whether patients have a morning or afternoon surgery?

Answer 8

Don’t take these medications on the day of the procedure

Question 9

When should SGLT2 inhibitors be ceased for day procedures?

Answer 9

Don’t take these medications on the day of the procedure

Question 10

When should SGLT2 inhibitors be ceased for surgeries requiring an overnight stay or bowel preparation?

Answer 10

At least 3 days before surgery

Question 11

When can all oral antihyperglycaemic agents be commenced post-operatively? (other than SGLT2Is)

Answer 11

when eating regular meals

Question 12

When can SGLT2Is be commenced post-operatively

Answer 12

When eating full oral intake. Consider waiting at least 24 hours

Question 13

If a patient has a basal-bolus insulin regimen, what should you advise them to do with their insulin for a morning procedure?

Answer 13

Continue long-acting insulin and withhold morning dose of short-acting insulin

Question 14

If a patient has a basal-bolus insulin regimen, what should you advise them to do with their insulin for an afternoon procedure?

Answer 14

Continue long-acting insulin and only have 1/2 morning dose of short-acting insulin

Question 15

If a patient has a mixed insulin regimen, what should you advise them to do with their insulin prior to their procedure?

Answer 15

Take 1/3 to 1/2 of their normal morning insulin