Peri-Operative Medicine

No need for pre-operative urinary culture

This study found that the use of preoperative urine cultures was associated with higher rates of surgical site infections, diarrhea and Cdiff infections; and bacteriuria alone was not associated with higher surgical site infections. Based on this, there does not appear to be an advantage to routinely checking preoperative urine cultures (abstract).

TKA volume markedly increased

In this large observational cohort of Medicare patients, the volume of total knee arthroplasty (TKA) increased 162% from 1991 to 2010, while revisions increased 106%. Length of stay dropped from 7.9 to 3.5 days, and 30 day readmissions increased from 4.2% to 5.0%. These increases bode well for hospitalist co-management services (abstract)

Preoperative hospitalist consult associated with lower mortality

This single institution study found that, compared to standard anesthesia preoperative evaluation, a hospitalist preoperative evaluation was associated with more beta blocker use, more stress tests, shorter length of stay (in those with ASA score>3) and lower inpatient mortality (1.3% vs 0.4%). A hospitalist preoperative clinic may improve postoperative mortality and LOS (abstract)

Cognitive function and delirium after cardiac surgery

In this cohort of 225 patients undergoing CABG or valve surgery, they were assessed with a mini-mental status exam (MMSE) and Confusion Assessment Method (CAM) preoperatively, daily from postoperative day 2 to discharge, and at 1, 6, and 12 months. Almost half (46%) developed delirium. At 6 months, the proportion of those that had not returned to baseline MMSE was significantly higher in those with delirium compared to those without (40% vs 24). Delirium prevention may improve long term cognitive function after cardiac surgery (abstract)

Preoperative hyponatremia associated with increased mortality

In this large registry analysis, of the 8% of patients who had preoperative hyponatremia (<135), mortality at 30 days was significantly higher than those without hyponatremia (5.2% versus 1.3%). It is not known, however, if delaying surgery or correcting the hyponatremia will lower the risk (abstract)