The pre-operative evaluation of patients to “clear” them for surgery and provide guidance on peri-operative management (especially medications) can represent challenging topics for housestaff and even physicians who have completed their formal training.
Deciding what diagnostics (EKG, CXR, blood work, stress testing, etc.) are recommended for a patient prior to a particular surgery, how to manage anticoagulation before and after the operating room, or selecting which patients will benefit from peri-operative beta-blockade are not necessarily easy tasks for the hospitalist, family physician, or primary care physician.
Given these challenges, Dr. Joshua Steinberg of Wilson Family Practice, in conjunction with the Computer Science Department at Binghampton University, has developed the PreOpEval App for the iPhone to assist physicians with these decisions.
Dr. Steinberg has developed a series of medically-oriented apps for the iPhone, including the WarfarinGuide and the PneumoniaGuide.
PreOp Eval organizes and presents much of the guidance that a healthcare provider needs in order to evaluate and prepare adult patients for non-cardiac surgery.
The content of the PreOpEval App is based on the consensus guidelines from the American College of Cardiology & American Heart Association (2007 & 2009), the Institute for Clinical Systems Improvement (2010), and the American College of Chest Physicians (2008).
As seen on the home screen, the PreOpEval App is organized around 1 algorithm and 3 resources:
- Stepwise approach to pre-operative cardiac evaluation (based on the ACC/AHA Guidelines)
- Perioperative medical management options (ACCP, ACC, ICSI)
- Timing of surgery after MI, stenting, and CABG (ACC)
- Non-cardiac pre-operative testing (ICSI, ACC)
We start by looking at the app’s algorithm for pre-operative cardiac evaluation, which is based on the ACC/AHA Consensus Guidelines. The first step of this algorithm is determining the urgency of the surgery in question – emergency vs urgent/elective.
For emergency surgery, the patient should proceed to the OR, regardless of prior cardiac status.
For urgent or elective surgery, evaluation depends on the presence or absence of active cardiac disease, which encompasses unstable coronary syndromes, severe CHF, certain arrhythmias, and severe valvular disease. In the case of active cardiac disease, the active cardiac disease should be evaluated, stabilized, and optimized prior to considering the OR.