Before a surgical procedure, in most patient cases, a pre-operative medical evaluation is ordered and accomplished. This is done to minimize any potential medical complications that could develop related to the stress of surgery, anesthesia, and changes in medications. Commonly referred to as “the medical clearance” evaluation, it is an important step to insure patient safety and quality care. We try to use the patient’s regular primary care physician to provide this service whenever possible. Since many patient’s arrive from out of town, or are “in between” medical physician’s, we often get involved to help place the patient with a local medical provider. In some cases, the patient will only be under the care of this physician for the “peri-operative period”. This means they will ultimately return for their routine general medical care to their primary care physician when they return to their home locale.
The pre-operative exam will often include a Chest X-ray and an EKG ( cardiac electrocardiogram) to screen for any acute or chronic respiratory or cardiac conditions. Routine blood-work is also ordered to check for anemia or electrolyte abnormalities. If any tests are abnormal, the patient will be sent for an additional evaluation with a cardiologist, pulmonologist, or medical sub-specialist as needed. It is common for more elderly patients, or those with an active cardiac condition such as atherosclerosis or heart rythym abnormality to get “cardiac clearance”. Patients who are asymptomatic but have a strong family history of cardiac disease will also see the cardiologist pre-op. Often a cardiac “stress test” is ordered, which can involve walking fast on a treadmill to speed the heartbeat up, while checking the ongoing concurrent EKG. More often, cardiac “stress” is artificially induced by injecting a medication in the patient’s IV that speeds the heart up, simulating the same physiologic effect of exercise. The function of the heart in response to this stress, tells us whether it is safe to proceed with your surgical procedure.ve a d
A history of renal (kidney function), liver disease ( hepatitis), gastrointestinal disease ( bleeding ulcer or diverticulitis), may also trigger an medical specialty consultation. Some of the more common conditions known to increase surgical risk are diabetes, hypertension, and bleeding / clotting disorders of the blood. These problems will be controlled and the patient will be “medically maximized” in preparation for surgery. Smokers, and patients who are very overweight, tend to have increased medical risk and we do our best to follow these patients closely. if you drink more than one glass of an alcoholic beverage a day, it can interfere with medications given in the hospital, or lead to a stressful “withdrawal” episode. If indicated, we will often give patients “a drink” with dinner to keep any possible negative physiological responses stable. We are very serious about preventing complications, so bear with us during the “inconvenience” of completing the medical clearance process. After your surgery, if indicated, a medical “hospitalist” will often be part of your care to check and treat any medical issues that arise. This may be a different doctor than the one who did the pre-op clearance! Hospitalists specialize in the treatment of in-hospital patients only, and often they do not have an outside office to see you after discharge.
Many of our patient’s now leave the hospital so quickly, that we do ask them to “follow-up” with their regular physician if problems develop after they are discharged to home. This is rare, and I encourage my patient’s to call me with any medical or surgical questions that come up in the early post-operative period. We will often bring you back to our office quickly if there is any concerns about the operative site or wound care. Call the office or Dr. Kozinn if you have questions. If there is a medical emergency that appears life or limb threatening, then please call “911” and/or head over to the nearest emergency room for fast evaluation and treatment.
Thankfully, peri-operative medical problems are not common, mostly because of all of our “pre-operative” medical preparations!