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Daniel Rauch, MD, FAAP, FHM Associate Professor of Pediatrics Icahn School of Medicine at Mount Sinai.

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Presentation on theme: "Daniel Rauch, MD, FAAP, FHM Associate Professor of Pediatrics Icahn School of Medicine at Mount Sinai."— Presentation transcript:

1 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 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 70s suggested utility More recent data: low yield of occult CXR findings that would delay operation

6 Possible Pre-op tests CXR Studies in 70s 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 Studies in 70s 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


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