Rethinking preop testing

“I think the reason we see changes in each of those … from pre to post when they implement, is because people start to communicate and collaborate,” she said. “I think that’s the secret sauce, and you can take that back home with you.”
 

Assessing risk

Paul Grant, MD, SFHM, codirector of the perioperative medicine pre-course, said that risk assessment is a crucial part of hospitalists’ role, and although risk calculators are available, “they’re not perfect – in fact, it’s important to think about using them very individualized for your patient.” Dr. Grant has begun using the Frailty Risk Analysis Index more often in his own work as director of the consultative and perioperative medicine program at Michigan Medicine, Ann Arbor, since frailty has been shown to be such a telltale indicator of perioperative risk.

As for preoperative testing, history is replete with examples of tests once considered crucial but that have proven to be unimportant for many patients, including preoperative carotid endarterectomy, preop ECG, preop coronary revasularization, and preop lab work.

“I was always listening for bruits years ago,” Dr. Grant said. “I’ve sort of stopped doing that now. You’ll hear it, you won’t know what to do with it. We used to take care of those things before surgery. We now know that’s not helpful for patients without symptoms.”