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: Comanagement is a structured collaboration between hospitalists and a surgical service to improve outcomes of surgical patients perioperatively. We identified the potential to improve patient safety and throughput metrics on the Surgical Oncology and Otolaryngology (ENT) services at our institution. We partnered with these two services to create a novel Surgical Oncology Comanagement Service. [...]

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: Although hip fractures in the elderly are largely due to osteoporosis, rates of treatment for osteoporosis after fragility fracture have been reported as

Background: Surgical site infections (SSI) can complicate any operative procedure although this risk is mitigated through the use of preoperative antibiotic prophylaxis.  While antibiotic prophylaxis can provide great benefit, inappropriate use can lead to the development of multi-drug resistant organisms causing increased morbidity, mortality, and cost. Although national clinical guidelines for preoperative antibiotics prophylaxis were [...]

Background: Studies have shown that early exposure to statins preoperatively have been associated with significant reductions in perioperative mortality and improved post-operative outcomes [1]. Despite guideline recommendations, use of statin therapy remains sub-optimal [2]. A retrospective study at our institution revealed over 40% of patients that presented to our preoperative optimization clinic were not on [...]

Background: Surgical risk stratification tools have existed since Goldman created the cardiac risk index in 1977. Since then, there has been a proliferation of risk calculators: the three most notable being the Revised Cardiac Risk Index (RCRI), the American College of Surgeons-Surgical Risk Calculator (ACS-SRC), and the Gupta Myocardial Infarction and Cardiac Arrest calculator (MICA). [...]

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. However, there is no published data comparing their performance. Methods: We retrospectively reviewed records of 663 patients seen in our preop clinic who [...]

Background: Choice of agent for venous thromboembolism prophylaxis (VTEP) after joint arthroplasty is a complex decision, the difficulty of which has been compounded by divergent guidelines. Specifically, the adequacy of aspirin monotherapy (ASA) for VTEP has long been debated between the American Academy of Orthopaedic Surgeons (AAOS) and the American College of Chest Physicians (ACCP). [...]

Background: Hip fracture (HP) involves bleeding that often requires blood transfusion and it can be life-threatening. Jehovah’s witnesses (JW) refuse blood products (BP) administration because of religious beliefs. Recombinant Human Erythropoietin (rHuEPO) has become an alternative but there are still no guidelines on its use in these situations. Methods: JW patients with HP admitted to [...]