Peri-Operative Medicine

Chronic beta blocker use better than acute for peri-operative outcomes

In this single center study of patients undergoing non-cardiac surgery, those that were chronically on beta blockers were 2.7 times less likely to have a bad outcome (eg MI, cardiac arrest, or death) compared to those who were started on a beta blocker in the peri-operative period (after adjusting propensity scores). This adds weight to the value of seeing patients in preoperative clinics far before surgery (when feasible) to assess who does and does not need to be on a beta blocker (abstract)

Coronary revascularization trends in the US

In this national database analysis, CABG rates declined significantly from 2001 to 2008, with the median caseload per hospital declining by 28%, whereas PCI rates were unchanged (abstract)

Audit and feedback to reduce foley duration

In this single institutional study, audit and feedback on foley prevalence and duration was provided to nurses on post-operative patients. Although CA-UTI rates were unchanged after the intervention, the % of patients with foley catheters for <3 days was significantly higher following the intervention. This is one reasonable strategy to reduce foley prevalence and duration in hospitalized patients (abstract)

Demographic changes in Medicare hip arthoplasty patients

In this observational cohort of medicare beneficiaries undergoing hip arthroplasty, from 1991 to 2008, the average age increased from 74 to 75, mean co-morbid illnesses increased from 1 to 2, and LOS dramatically dropped from 9.1 to 3.7 days, while 30 day mortality decreased from 0.7% to 0.4% (although 30 day readmission increased from 6% to 8.5%). The percentage of those discharged to home also substantially decreased (from 68% to 48%). Hip arthoplasty patients are older, sicker, stay longer, are less likely to go home, and are more likely to be readmitted. These statistics alone make a very strong argument for surgical-co-management (abstract)

Outcomes of patients with peri-operative MI

In this analysis of the POISE trial, 5% of patients suffered a peri-operative MI. 3/4 of them occurred within 48 hours, and 2/3 did not have any symptoms. 30 day death was 12% (versus 2% in post-op patients without an MI). Post-op MI is still relatively common, often asymptomatic, and associated with high mortality. This may justify the use of EKG monitoring in high risk patients shortly after surgery (abstract)