Why Bother? The Comprehensive Pre-Op Panel for kids – NOT!

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Presentation transcript:

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

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

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

Possible Pre-op tests CXR

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

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!

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

Possible Pre-op tests Surely Type and Cross?

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

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?

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

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?

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

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