The Medical clinics of North America
-
Perioperative risks associated with acute hepatitis, cirrhosis, and chronic kidney disease are substantial and prevalence of underlying chronic kidney or liver disease is rising; surgeries in these populations have accordingly become more common. Optimal perioperative management in both cases is paramount; this article focuses on understanding disease pathophysiology, a targeted preoperative evaluation, accurate estimation of perioperative risk, and anticipation and management of common postoperative complications.
-
Med. Clin. North Am. · Nov 2024
ReviewCoronary Disease Risk Prediction, Risk Reduction, and Postoperative Myocardial Injury.
For patients considering surgery, the preoperative evaluation allows physicians to identify and treat acute cardiac conditions before less-urgent surgery, predict the benefits and harms of a proposed surgery, and make temporary management changes to reduce operative risk. Multiple risk prediction tools are reasonable for use in estimating perioperative cardiac risk, but management changes to reduce risk have proven elusive. For all but the most urgent surgical procedures, patients with active coronary syndromes or decompensated heart failure should have surgery postponed.
-
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.
-
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.
-
The preoperative care of patients with cancer plays a pivotal role in ensuring optimal outcomes and enhancing the overall quality of life for individuals undergoing surgical interventions. This review aims to provide a comprehensive overview of the key considerations, challenges, and strategies involved in the preoperative management of oncology patients. We delve into the multidisciplinary approach required to address the unique needs of this patient population, emphasizing the importance of collaboration among surgeons, oncologists, anesthesiologists, primary care physicians, hospitalists, and other health care professionals.