P001: PREOPERATIVE CARE FOR PATIENTS SCHEDULED FOR LOW-RISK AMBULATORY PROCEDURES UNDER MINIMAL SEDATION: A REVIEW OF 853 PATIENTS
Vianca C Insignares, MD; Hong Liang, DO; Nigel Gillespie, MD; Alberto Ardon, MD; Sher-Lu Pai, MD; Mayo Clinic
Introduction: The preoperative evaluation (POE) clinic provides a complete patient assessment with the goals of medical optimization prior to surgery and improving patient safety and outcomes. Controversies exist regarding the impact of preoperative testing and evaluation for ambulatory patients having low-risk procedures under minimal or no sedation. Cataract surgery and pain medicine procedures are two such examples. The Society for Ambulatory Anesthesia (SAMBA) released a position statement that says there is no benefit of routine testing for patients with comorbidities before cataract surgery. As studies have found minimal benefits from POE for patients undergoing low-risk procedures, we aim to examine the impact of our current POE clinic practice for patients scheduled for low-risk procedures under minimal sedation.
Methods: A retrospective chart review was performed for patients scheduled for cataract or pain medicine procedures and received preoperative evaluation at the POE Clinic at Mayo Clinic in Florida between January 1, 2017, and December 31, 2018. Patients under the age of 18 years were excluded. Patients who underwent cataract and pain procedures, but required a higher degree of sedation, were also excluded. Collected data encompassed patient demographics, new diagnoses after preoperative evaluation, surgical cancelation or delay, and postoperative complications.
Results: Of a total of 853 patients included in this study, 530 were scheduled for cataract surgery, and 322 scheduled for pain medicine procedures. 480 (56.3%) patients were female and 373 (43.7%) were male. Patients had an age median (range) of 71 (18.0; 94.0) and mean (SD) of 68.9 (12.0) years old. 131 patients (15.4%) had new diagnoses made at the POE clinic. Of the 131 patients, the most common new diagnoses were anemia (n=41; 31.3%), chronic kidney disease (n=24; 18.3%), and thrombocytopenia (n=21; 16.0%). Conditions causing delay or cancelation are listed in Table 1. For post-operative complication, only one patient (0.1%) was reported to have hospital admission due to poor pain control.
Discussion: Cataract and pain medicine procedures are low-risk and require minimal or no sedation. The impact of the POE clinic in this patient population was minimal. The SAMBA positional statement regarding pre-operative care for cataract surgery supports preoperative testing only if the patient presents with “a severe medical problem that warrants evaluation even without planned surgery.” Our study results affirm this statement. Very few comorbidities are severe enough to merit the cancelation or delay of cataract surgery. Hypertension, diabetes mellitus, and new onset atrial fibrillation in patients scheduled for low-risk ambulatory surgery should not be delayed outside of presentation with extreme arterial pressures, ketoacidosis/hyperosmolar nonketotic states, or hemodynamically instability according to the literature. Newly diagnosed medical conditions by the POE clinic can provide long-term health benefits for patients but our results did not provide evidence these new diagnoses improve perioperative outcomes or reduce postoperative complications. This study prompted changes within our surgical practice and patients scheduled for cataract or pain medicine procedures stopped receiving POE consultation December 2021.
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