Background: Preoperative diastolic dysfunction has been proposed as an independent predictor of major adverse cardiac events (MACE) and death after non-cardiac surgery. However, most studies supporting this association have included non-emergent procedures and utilized E/e’ ratio as the predominant echocardiographic variable evaluating diastolic function. Compared to patients undergoing elective surgeries, hip fracture surgery patients are [...]

Background: Enhanced Recovery After Surgery (ERAS) is a framework or pathway of standardized preoperative, intraoperative, and postoperative elements shown to improve recovery after a surgical operation (Table 1). ERAS has shown benefits in pediatrics by reducing hospital length of stay, opioid use, readmission rates, health care costs and improving patient satisfaction scores(1,2). At our institution, [...]

Background: Hip fracture surgery is associated with a significant incidence of postoperative myocardial infarction (postop-MI) up to 14% in the first 7 days after repair. Patients who sustain postop-MI have 1-year mortality rates up to 36%. However, the impact of risk factor modification and routine troponin monitoring on the incidence and prognosis of postop-MI remains [...]

Background: Perioperative medicine focuses on providing patient-centered care throughout the pre-operative and post-operative periods. This area of medicine is critical given its potential to limit complications, improve post-operative outcomes, and decrease the duration of hospitalization after surgery. In recent years, perioperative medicine teaching during residency has become a requirement by The Accreditation Council for Graduate [...]

Background: Gastric Point-of-Care Ultrasound (POCUS), has been validated for perioperative pulmonary aspiration risk reduction, but data on medical inpatients is lacking (1). Inpatients often have multiple risk factors for delayed gastric emptying, but may need urgent surgery or procedures. According to the American Society of Anesthesiologists (ASA), a fasting period of 2, 6, and 8 [...]

Background: Chronic kidney disease (CKD) is associated with adverse perioperative outcomes, including mortality, with risk increasing with severity of CKD. (1) Long term dialysis is also associated with pneumonia, unplanned intubation, reoperation, and vascular complications. (2) Common preoperative practices for end stage renal disease (ESRD) patients include measuring day of surgery (DOS) potassium levels. Little [...]

Background: Current guidelines recommend continuing aspirin during elective non-cardiac surgery in 1) patients with prior percutaneous coronary intervention (PCI) if the bleeding risk allows and 2) patients without prior PCI if thrombotic risk outweighs bleeding risk. Comparing the risk of thrombosis and bleeding is frequently inexplicit, particularly in low and intermediate bleeding risk surgery. The [...]

Background: Internal Medicine physicians are increasingly involved in Perioperative care. Medicare claims data in colectomy & total hip arthroplasty patients shows >50% had a medicine consult (1) Surgeons, when surveyed, felt Internist’s role in preoperative risk stratification and medication management were vital (2).In one study, 82.2% of medical consultations came from surgical services commonly from [...]