Reducing Infection Rates with Enhanced Preoperative Diabetes Mellitus Diagnosis and Optimization Processes.

Objectives: Hyperglycemia and increased preoperative hemoglobin A1c (HbA1c) are associated with perioperative morbidity and death. For nonurgent operations, adequate glycemic control before surgery is recommended. Our surgical practice needed a process for preoperative diabetes mellitus (DM) diagnosis and glycemic optimization.

Impact of Preoperative Testing on Patients Undergoing Ophthalmologic Surgery: A Retrospective Cohort Study.

Objective: Routine medical testing is not recommended before cataract surgery, but no consensus exists about preoperative testing before general ophthalmologic surgery. We aimed to assess the impact of preoperative testing on patients undergoing ophthalmologic surgery by analyzing their surgical outcomes and complications.

Methods: We retrospectively reviewed electronic health records of patients who had preoperative evaluations before cataract or noncataract ophthalmologic surgery at a tertiary care center from January 1, 2015, through December 31, 2019.

Perioperative Resumption of Direct Oral Anticoagulants: Review of the Mayo Clinic Experience.

Objective: We aimed to review recommendations for the postoperative resumption of direct oral anticoagulants (DOACs) and report complications 30 days postoperatively.

Methods: We retrospectively reviewed patients receiving DOAC therapy who underwent preoperative evaluations from January 1, 2015 through May 30, 2018. We noted days that DOAC therapy was withheld, postoperative time until resumption of the DOAC, and complications within 30 postoperative days.

Retrospective Evaluation of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers on Postoperative Estimated Glomerular Filtration Rates Following Robotic-Assisted Partial Nephrectomy.

To evaluate the association between the use of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) preoperatively with changes in estimated glomerular filtration rate (eGFR) after robotic-assisted partial nephrectomy (RAPN). Patients undergoing RAPN at our institution from February 2008 through April 2019 were evaluated. ACEIs/ARBs were held on the morning of the surgery and resumed on postoperative day number one in all patients.

Responding to the COVID-19 Pandemic: A New Surgical Patient Flow Utilizing the Preoperative Evaluation Clinic.

During the coronavirus disease 2019 (COVID-19) pandemic, the study institution recognized the importance of providing preoperative COVID-19 testing and symptom screening to ensure patient safety. A multidisciplinary quality improvement team used Define, Measure, Analyze, Improve, and Control methodology to understand the issues, identify solutions, and streamline patient flow. The existing preoperative evaluation (POE) clinic was utilized as a centralized entity to provide COVID-19 testing, symptom screening, and infection prevention education in addition to routine preoperative medical optimization.

COVID-19 infection: Strategies on when to discontinue isolation, a retrospective study.

Objective: Add to available understanding of COVID-19 to help decrease further spread of SARS-CoV-2 by providing protocol providers can consider when giving patients recommendations to retest as well as length of time for self-isolation.

Methods: We retrospectively collected data from the electronic medical record of patients in the Mayo Clinic Florida's COVID Virtual Clinic. Hundred and eighteen patients with detectable results for the virus were followed.

Improving Value of Care: Cessation of Screening Urine Culture Prior to Orthopedic and Spinal Surgery.

Objective: To assess the impact of cessation of screening urine cultures on surgical site infection (SSI) incidence in clinical practice.

Patients And Methods: Our study included patients undergoing hip replacement, knee replacement, spinal fusion, and laminectomy 12 months before (preintervention) and after (postintervention) cessation of preoperative screening urine cultures on June 1, 2017, at our institution. Urine cultures and urinalyses performed within 30 days before surgery during the 12 months before and after cessation were reviewed.

Improving satisfaction with postoperative pain management for patients with persistent pain: a preoperative pain medicine consultation intervention.

Purpose: Preoperative pain medicine consultations with opioid-tolerant patients allow for an accurate medication history, patient involvement in the postoperative plan, and realistic goal setting. The purpose of this quality improvement project was to increase attendance at preoperative pain consultations, thereby increasing patient satisfaction.

Methods: Retrospective chart reviews identified patients who had a preoperative pain consultation ordered from May through July 2016.

Cost-Utility of Routine Testing in Chronic Urticaria/Angioedema: A Cohort Study.

Background: Chronic urticaria/angioedema (CUA) guidelines recommend limiting tests to diagnose and assess prognosis, activity, and severity. Routine testing in CUA might substantially increase cost of disease without benefiting outcome.

Objective: To evaluate the utility of tests in CUA and how they influence the cost of disease.

Preoperative Evaluation Clinic Redesign: An Initiative to Improve Access, Efficiency, and Staff Satisfaction.

In 2008, Mayo Clinic in Jacksonville, Florida, developed the preoperative evaluation (POE) clinic under the department of anesthesiology to provide preoperative history and physical examination, and medical optimization. Over time, the POE clinic expanded to accommodate more than 90% of surgical patients, outgrowing the initial practice model. The increased patient volume with shortened turnaround times bottlenecked patient access.

Perioperative Management of Female Hormone Medications.

Background: No clear guideline exists for the management of female hormone therapy in the perioperative period. Besides oral contraceptives (OCPs), hormone medications have been prescribed to treat cancer, osteoporosis, and menopausal symptoms. Since the introduction of OCPs in the 1960s, the thromboembolic risk associated with these medications has been studied and alterations have been made in the hormone content.

Pharmacologic and Perioperative Considerations for Antihypertensive Medications.

Background: As the prevalence of hypertension continues to increase, physicians routinely encounter patients preoperatively receiving one or more cardiovascular medications to manage hypertension. Thus, the physician's knowledge of perioperative antihypertensive medication management is crucial to ensure patient safety.

Objective: We discuss the decisions to continue or stop antihypertensive medications to reduce the risk of perioperative complications.

Perioperative Management of Beta Blockers and Other Antiarrhythmic Medications.

Background: Antiarrhythmic medications are an important tool in preventing recurrence of intraoperative and postoperative arrhythmias.

Objective: To review current literature and recommendations for perioperative management of antiarrhythmic medications.

Methods: Literature review is presented along with the pharmacology of antiarrhythmics.

Perioperative Management of Anticoagulants.

Background: The prevalence of anticoagulant use has increased in the United States. Medical providers have the responsibility to explain to patients the management of anticoagulant regimens before an invasive procedure. The pharmacologic characteristics of these medications, specifically their half-lives, are important in timing an interruption of anticoagulant therapy.

Pharmacology and Perioperative Considerations for Diabetes Mellitus Medications.

Background: Given the prevalence of diabetes mellitus in modern society, health care providers are frequently tasked with managing glucose control in the perioperative period. When determining perioperative diabetes management, the clinician must balance the need to maintain relative euglycemia at the time of surgery with preventing hypoglycemia or hyperglycemia in a fasting surgical patient. This balance requires an understanding of the pharmacology of these medications, the type of surgery, and the patient's degree of diabetic control.

Proximal tubular dysfunction associated with tenofovir and didanosine causing Fanconi syndrome and diabetes insipidus: a report of 3 cases.

We report 3 cases of patients with HIV/AIDS in whom Fanconi syndrome and nephrogenic diabetes insipidus developed secondary to use of an antiretroviral regimen containing tenofovir disoproxil fumarate and didanosine. These patients presented with a history of polydipsia, polyuria, weight loss, anorexia, and wasting. Interestingly, 1 patient was not taking protease inhibitors.