Why Bother? The Comprehensive Pre
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Transcript Why Bother? The Comprehensive Pre
Daniel Rauch, MD, FAAP, FHM
Associate Professor of Pediatrics
Icahn School of Medicine at Mount Sinai
Which kids go to the OR electively?
Previously healthy kids
T&A, pyloromyotomy, inguinal hernia repair,
appendectomy, orthopedic repair, hypospadias repair
Children with Special Healthcare Needs (CSHCN)
Fundoplication, G-tube placement, tendon release,
shunt placement/repair
Who takes kids to OR?
Tertiary care facilities
Surgeons with pediatric training
Post-op care with pediatric specialists
Community facilities
Surgeons with pediatric experience but less commonly
with pediatric training
Post-op care less likely with pediatric specialists
Possible Pre-op tests
CXR
Possible Pre-op tests
CXR
Studies in 70’s suggested utility
More recent data: low yield of occult CXR findings that
would delay operation
Possible Pre-op tests
CXR
Studies in 70’s suggested utility
More recent data: low yield of occult CXR findings that
would delay operation
CBC – surely we need a pre-op HCT!
Possible Pre-op tests
CXR
Studies in 70’s suggested utility
More recent data: low yield of occult CXR findings that
would delay operation
CBC – surely we need a pre-op HCT! NO!!
Declining incidence of anemia (less Fe deficiency)
Most procedures with minimal blood loss
High threshold for transfusion
Possible
Pre-op
tests
Surely Type and Cross?
Possible
Pre-op
tests
Surely Type and Cross?
Most procedures with minimal blood loss
Possible
Pre-op
tests
Surely Type and Cross?
Most procedures with minimal blood loss
PT/PTT? – How will we know if there may be
bleeding?
Possible
Pre-op
tests
Surely Type and Cross?
Most procedures with minimal blood loss
PT/PTT? – How will we know if there may be
bleeding?
Labs less accurate than Hx (pt and fam)
Not even for T&A
Possible
Pre-op
tests
Surely Type and Cross?
Most procedures with minimal blood loss
PT/PTT? – How will we know if there may be
bleeding?
Labs less accurate than Hx (pt and fam)
Not even for T&A
Not even BMP/Chem 7?
Possible
Pre-op
tests
Surely Type and Cross?
Most procedures with minimal blood loss
PT/PTT? – How will we know if there may be
bleeding?
Labs less accurate than Hx (pt and fam)
Not even for T&A
Not even BMP/Chem 7?
No routine benefit
What
can
we
do?
History and Physical Exam
When possible well in advance of procedure especially
for CSHCN
Testing as indicated by pre-op visit or occasionally as
necessitated by procedure
There are some bloody procedures
Good opportunity to review general care and address
issues that may impact on post-op care
Good evidence this reduces cost and LOS