1. Why Bother? The Comprehensive Pre-Op Panel for kids – NOT!
Daniel Rauch, MD, FAAP, FHM
Associate Professor of Pediatrics
Icahn School of Medicine at Mount Sinai

2. Which kids go to the OR electively?
Previously healthy kids
T&A, pyloromyotomy, inguinal hernia repair, appendectomy, orthopedic repair, hypospadias repair
Children with Special Healthcare Needs (CSHCN)
Fundoplication, G-tube placement, tendon release, shunt placement/repair

3. Who takes kids to OR? Tertiary care facilities Community facilities
Surgeons with pediatric training
Post-op care with pediatric specialists
Community facilities
Surgeons with pediatric experience but less commonly with pediatric training
Post-op care less likely with pediatric specialists

4. Possible Pre-op tests
CXR

5. Possible Pre-op tests CXR Studies in 70’s suggested utility
More recent data: low yield of occult CXR findings that would delay operation

6. Possible Pre-op tests CXR CBC – surely we need a pre-op HCT!
Studies in 70’s suggested utility
More recent data: low yield of occult CXR findings that would delay operation
CBC – surely we need a pre-op HCT!

7. Possible Pre-op tests CXR CBC – surely we need a pre-op HCT! NO!!
Studies in 70’s suggested utility
More recent data: low yield of occult CXR findings that would delay operation
CBC – surely we need a pre-op HCT! NO!!
Declining incidence of anemia (less Fe deficiency)
Most procedures with minimal blood loss
High threshold for transfusion

8. Possible Pre-op tests
Surely Type and Cross?

9. Possible Pre-op tests Surely Type and Cross?
Most procedures with minimal blood loss

10. Possible Pre-op tests Surely Type and Cross?
Most procedures with minimal blood loss
PT/PTT? – How will we know if there may be bleeding?

11. Possible Pre-op tests Surely Type and Cross?
Most procedures with minimal blood loss
PT/PTT? – How will we know if there may be bleeding?
Labs less accurate than Hx (pt and fam)
Not even for T&A

12. Possible Pre-op tests Surely Type and Cross?
Most procedures with minimal blood loss
PT/PTT? – How will we know if there may be bleeding?
Labs less accurate than Hx (pt and fam)
Not even for T&A
Not even BMP/Chem 7?

13. Possible Pre-op tests Surely Type and Cross?
Most procedures with minimal blood loss
PT/PTT? – How will we know if there may be bleeding?
Labs less accurate than Hx (pt and fam)
Not even for T&A
Not even BMP/Chem 7?
No routine benefit

14. What can we do? History and Physical Exam
When possible well in advance of procedure especially for CSHCN
Testing as indicated by pre-op visit or occasionally as necessitated by procedure
There are some bloody procedures
Good opportunity to review general care and address issues that may impact on post-op care
Good evidence this reduces cost and LOS