Assessment focus: are there barriers to surgery?

Plan:

1. Cardiac rRsk

30 Day risk of morbidity

https://www.mdcalc.com/calc/1739/revised-cardiac-risk-index-pre-operative-risk

• Preop Cardiac Risk Evaluation

2. Diabetes Management

• using a drip is RARE (think: T1D ; ~200 U of insulin in a T2D)

• SGLT2i: start holding 3 days before OR (risk of euglycemic DKA)

• Night before: 50%-75% of night time insulin (if better controlled [based on A1C, CBG], consider closer to 50%

• While NPO, hold all mealtime insulins

3. Anticoagulation/Antiplatelet

• if within 3-6 months of an MI, continue ASA (w/ or w/o DES)

• consider recommending to defer surgery if within 3 months of an MI

1. Pulmonary Risk

https://www.mdcalc.com/calc/10022/ariscat-score-postoperative-pulmonary-complications

Suggest: early mobilization with PT/OT, incentive spirometry