The Medical clinics of North America
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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.
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Med. Clin. North Am. · Nov 2024
ReviewPerioperative Care of Heart Failure, Arrhythmias, and Valvular Heart Disease.
Frequently, the question of whether or not a patient is stable for surgery boils down to the question, "Does this patient need a preoperative stress test?" However, coronary artery disease and ischemic heart disease are only some of the many cardiac conditions that patients present with preoperatively-and that can negatively impact their intraoperative management and postoperative outcomes. This article will explore the evidence based, patient centered best practices surrounding the perioperative evaluation and management of heart failure, arrhythmias, and valvular heart disease.
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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.
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Medication management in the perioperative period is a critical part of the decision-making prior to surgery. While randomized trial levels of evidence in this space are scant, retrospective data and expert consensus provide practical guidance for these decisions. Clinicians must understand risks and benefits of withholding versus continuing medications, stop medications based on pharmacokinetics and effect on primary disease and surgical risk, and resume medications after surgery in a timely manner. Knowing alternate routes of medication administration can help keep chronic disease processes stable through surgery.