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Getting a "Green Light" for Surgery

Steven Skildum, M.D.

 

Surgical specialists often refer patients back to their primary care provider for a preoperative consultation (commonly called a “preop”). The primary care provider often knows the patient’s full medical status, and is thus very qualified to determine a patient’s ability to undergo anesthesia and a surgical procedure. During the preop exam, the primary care provider evaluates any medical conditions the patient currently has. He or she also identifies any potential surgical risks to the heart, lungs, kidneys, or other vital organs. The goal is to assess and improve the patient’s medical condition so the patient is the healthiest he/she can possibly be when going into surgery.
 
There are two types of surgical risksprocedural risks and patient-specific risks. Procedural risks can be rated as low (such as cataract surgery), intermediate (such as prostate surgery) or high (such as major heart surgery). Patient-specific risk is determined by doing lab tests and assessing a patient’s overall health.
 
Cardiac (heart) health is very important. Sometimes cardiac health can be very simply stated after asking a patient what activities he can do. For example, one patient may be able to bowl, golf, or climb stairs slowly, and he would be rated at 4 METS (METS stand for Metabolic Equivalents). Another patient might be able to perform strenuous sports,
hockey, swimming, or downhill skiing and he would be rated at 10 METS. In general, a patient who can function at 4 METS or greater is considered to be a better risk for
surgery.
 
Your provider will be interested in your complete heart history, including any prior surgeries for stents, artificial valves, or a pacemaker. He will also fully assess your lungs and breathing, and take note of risks such as sleep apnea, asthma, smoking, etc. He will review all medications you are taking, including those that might affect blood clotting. He will help manage your medications before and after surgery.
 
The anesthesiologist and surgeon have the final decision-making power about whether to give a “green light” for proceeding with surgery. A primary care provider’s role is to help assure the best surgical result possible, by identifying a patient’s medical status and maximizing the state of health before the operation takes place.

 

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