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Medical Consultation and Co-Management in Perioperative Medicine


NATIONAL HARBOR, MD—Amir Jaffer, MD, and Steven Cohn, MD, chaired an excellent pre-course centered on common problems hospitalists encounter in managing medical problems in surgical patients. Topics covered were: the pre-operative evaluation and role of the consultant, cardiac risk assessment, pulmonary risk assessment, perioperative medication management, old and new antithrombotic therapy, diabetes management, co-management of the hip fracture, VTE prevention, and management of perioperative anemia.

Among other takeaway points, the physicians emphasized the importance of personal communication between surgeons and hospitalists. Frank Michota, MD, made an analogy using the patient as the plane, the surgeon as the pilot, the anesthesiologist as the co-pilot, and the hospitalist as the mechanic.

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Others commented on cardiac management of the surgical patient, the risk assessment calculators available, and how noninvasive testing is rarely needed. Physicians also noted that partial functional dependence is the strongest predictor for patients needing recommendations regarding risk of postoperative respiratory failure. In reviewing patients’ medications in the perioperative phase, the speakers noted it is important to ask about herbal remedies and OTC drugs, as these may cause problems during and after surgery.

Additional topics addressed included: bridge therapy for anti coagulation, and the need to take into account the risk of bleeding among some, but not all, patients; how diabetic management should focus on a pre-meal glucose measurement of less than 140 mg/dl, and that all other glucose readings be under 180 mg/dl; how extended prophalyxis for VTE prevention is needed for elective hip surgery; and that hospitalists should be versed in the latest recommendations regarding restricted blood transfusion criteria. TH

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