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

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

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

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  1. Why Bother? The Comprehensive Pre-Op Panelfor 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 • 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 • 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 • 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

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