The Medical clinics of North America
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Preoperative medical evaluation can minimize inefficiencies and improve outcomes. Thoughtful use of preoperative testing can aid in that effort, but, conversely, indiscriminate testing can detract from it. ⋯ Testing is supported only when clinical indications are present. Particularly in low-risk patients, such as those with an ASA classification of 1 or 2 who are undergoing ambulatory procedures, evidence suggests that preoperative testing fails to reduce the risk of complications.
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Surgery under anesthesia poses a significant stress to the body, and postoperative complications occur in up to 20% of cases. An understanding of postoperative complications, including assessment of patients at risk, risk mitigation, early recognition, and evidence-based treatment, is essential to provide high-value health care. Common postoperative complications reviewed in this article include fever, cerebrovascular accident, nausea and vomiting, ileus, and urinary retention, including discussion of pathophysiology, prevention, and treatment.
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Med. Clin. North Am. · Nov 2024
ReviewThe Geriatric Patient: Frailty, Prehabilitation, and Postoperative Delirium.
Historically and for ease of classification, the geriatric patient has received a chronologic definition of a person 65 years and older. Chronologic age remains an independent risk of postoperative complications and adverse surgical outcomes. ⋯ The concept of prehabilitation has shown promise as a proactive approach to optimize a patient's functional, cognitive, nutritional, and emotional in preparation for surgical interventions. Postoperative delirium is the most common neuropsychological complication after surgery.
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Hospital medicine grew rapidly, creating a group of providers excelling at providing high-value and high-quality care. Consultative medicine aims to answer specific questions regarding aspects of a patient's care. ⋯ Outcomes of comanagement services are mixed, likely related to the variability with how they are structured. A successful comanagement model involves a thoughtful and detailed approach.
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Hip fractures are a frequent cause of hospitalization in the elderly population and can lead to significant morbidity and mortality. As the population continues to age, the incidence of hip fractures is expected to increase. The internist/hospitalist plays a critical role in the care of this population as many patients have multiple medical comorbidities. Management of the fragility hip fracture patient requires knowledge of several perioperative topics including preoperative risk assessment, risk reduction strategies, the optimal timing of surgical repair, venous thromboembolism prevention, and postoperative care considerations such as early mobilization with physical therapy, and osteoporosis treatment.