Background: The 2014 ACC/AHA Perioperative Guidelines suggest using the Revised Cardiac Risk Index (RCRI), myocardial infarction or cardiac arrest (MICA), or American College of Surgeons (ACS)-NSQIP calculators for combined patient-surgical risk assessment. Alrezk and colleagues recently published a new geriatric-sensitive cardiac risk index (GS-CRI) to predict MI or cardiac arrest in the geriatric population. We [...]

Background: Risk of having a major adverse cardiac event in the perioperative period is known to be raised among those with underlying cardiovascular disease undergoing noncardiac surgery. ACC/AHA 2014 guideline is an excellent tool for the physicians to evaluate perioperative cardiac risk. However, the evidence-based set of algorithms are often under- or inappropriately utilized due [...]

Background: The care of surgical patients is becoming more complex as patients with increasing comorbidities require surgical procedures. In adult hospital medicine, co-management of complex medical patients by hospital medicine and surgery has been shown to decrease length of stay and readmission for many procedures. It remains unclear, however, which patients are most likely to [...]

Background: Recent data suggest that there are mortality benefits from preoperative statin therapy in patients at high risk for atherosclerotic cardiovascular disease (ASCVD). Current guidelines recommend moderate or high intensity statin for all patients with established ASCVD or 10-year risk of > 7.5%. In our preoperative evaluation clinic which is staffed by hospitalists, there were [...]

Background: Perioperative hyperglycemia is associated with poor surgical outcomes, including infection and mortality, with higher rates of complications in patients without diagnosed diabetes (NDM) than in those with diabetes. Insulin therapy has been found to decrease the risk of infection and other adverse outcomes following surgery. It is unclear, however, whether insulin therapy for hyperglycemia [...]

Background: Patients with increasing age and medical complexity are undergoing colorectal surgery. Medical complications are not uncommon, and may contribute to higher mortality. We implemented a unique surgical co-management (SCM) model in July 2014 at our institution where two SCM hospitalists were dedicated to Colorectal surgery year round. Each patient was screened daily by a [...]

Background: High risk patients undergoing elective surgery are at increased risk of life-threatening complications. Also, most are under anesthesia, lacking capacity for at least that time. Despite this they often lack advance directives (ADs) or do not have them accessible in their medical records. Methods: We did a retrospective chart review of 231 patients seen [...]

Background: Hip fractures are a major health problem in the geriatric population in the United States, with estimated costs of $18B annually. Hip fractures are highly morbid in the elderly, as deconditioning and acute complications compound chronic comorbidities. To improve care for this high-risk population, hip fracture patients are preferentially admitted to our medicine hospitalist [...]

Case Presentation: A 62 YO woman with PMHx significant for type 2 DM, HTN, CAD with a previous MI, and OSA was recovering as expected from elective decompressive laminectomy. On POD 4 she developed nausea, confusion, and lethargy. The hospitalist service was consulted, prompting a metabolic work-up that suggested anion gap metabolic acidosis. There were [...]