Preoperative Assessment of Colorectal Patients
A thorough and detailed preoperative patient assessment is the first, and can be the most critical, step in the treatment of a colorectal surgery patient. A comprehensive understanding of the patient’s presentation and medical history can reveal cardiac,
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Key Concepts • A thorough history and physical exam performed by the surgeon is the single best preoperative “test.” • Complex surgical patients with multiple comorbidities need careful preoperative assessment in order to minimize risk of perioperative complications. • Preoperative laboratory studies should be ordered on a selective basis, as “routine” preoperative labs on otherwise asymptomatic, healthy patients have low diagnostic yield. • Depending on patient’s risk factors, a preoperative cardiac risk assessment should be made and appropriate testing obtained. Cardiac medications should be continued, although beta blockers should not be initiated in the preoperative setting. Cardiac interventions should be performed for standard indications, independent of the need for abdominal surgery. • Smoking cessation should be strongly encouraged prior to elective surgery. • The surgeon should carefully review the patient’s medication list, paying particular attention to anticoagulants, immunosuppressants, and chemotherapy agents.
Evaluation of the Routine Colorectal Patient In Office by Surgeon The in-office surgical consultation, including a detailed history and physical exam performed by the surgeon, is the single most important part of the preoperative evaluation. This also includes a thorough review of the patient’s medical record, which often will uncover additional relevant medical and surgical history, as well as medications. Particularly for complex patients with known cardiopulmonary disease or other major comorbidities (as well as patients with surgical diseases involving multidisciplinary care teams such as inflammatory
bowel disease (IBD) and rectal cancer), it is essential to obtain the names, phone numbers, and e-mail addresses of the patients’ specialists for further communication and coordination of care. Many patients shuttle between different hospital systems and despite advances in information technologies, fluid communication between specialists remains challenging. The task of coordinating these patients’ preoperative care can be enormously time-consuming for the busy surgeon; however, it is incredibly important to communicate and exchange vital information prior to elective surgery, in order to minimize risk of perioperative complications.
Major Abdominal Surgery It goes without saying that the surgeon should personally perform a detailed history and physical examination of every patient undergoing elective abdominal surgery. The history should make sure to include a detailed list of active medications, including blood thinners and over-the-counter drugs or topical agents. The history should include complementary or alternative medicine practices and substances. Personal and/or family history of clotting or bleeding disorders (or bleeding complications from prior surgery) should be obtained. Additionally, the surgeon should ask about activity level, in order to estimate exercise capacity. Poor baseline exercise capacity has been shown to correlate with increased risk of perioperative cardiac com
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