An evidence-based approach to perioperative care: Update for the primary care physician

Kevin J. O'Leary, Martin J. Arron, Frank Lefevre, Vinky Chadha, Steven Lawrence Cohn

Research output: Contribution to journalArticle

Abstract

• Objective: To review the general principles of perioperative care for the primary care physician. • Methods: Qualitative assessment of the literature. • Results: A thorough history and physical examination provides the foundation of the preoperative evaluation. Laboratory testing generally should be performed when indicated rather than as routine screening prior to surgery. The American College of Cardiology and the American Heart Association have published consensus guidelines to guide the clinician on assessing cardiac risk, the potential benefit of noninvasive testing (eg, exercise electrocardiography [ECG], exercise or dobutamine stress echocardiography, and stress myocardial perfusion imaging), and the benefit of various management options. The indications for coronary artery bypass grafting and percutaneous coronary intervention prior to noncardiac surgery are identical to those for patients in which these procedures would otherwise be indicated. β-Blocker therapy has been shown to reduce the risk of perioperative cardiac death or myocardial infarction in selected patients. In patients with high or intermediate clinical risk who have known or suspected coronary artery disease and who are undergoing high or intermediate risk procedures, the most cost-effective strategy for postoperative monitoring is to obtain a 12-lead ECG immediately after surgery and on the first 2 days postoperatively. • Conclusion: With knowledge of established risk factors obtained from a thorough history and physical examination and application of evidence-based guidelines, the physician can order appropriate testing and targeted interventions to maximize beneficial outcomes.

Original languageEnglish
Pages (from-to)351-366
Number of pages16
JournalJournal of Clinical Outcomes Management
Volume11
Issue number6
StatePublished - Jun 2004
Externally publishedYes

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Perioperative Care
Primary Care Physicians
Physical Examination
Electrocardiography
History
Guidelines
Exercise
Stress Echocardiography
Myocardial Perfusion Imaging
Percutaneous Coronary Intervention
Coronary Artery Bypass
Coronary Artery Disease
Myocardial Infarction
Physicians
Costs and Cost Analysis
Evidence-based
Primary care physicians
Surgery
Testing
Therapeutics

ASJC Scopus subject areas

  • Medicine(all)
  • Strategy and Management

Cite this

O'Leary, K. J., Arron, M. J., Lefevre, F., Chadha, V., & Lawrence Cohn, S. (2004). An evidence-based approach to perioperative care: Update for the primary care physician. Journal of Clinical Outcomes Management, 11(6), 351-366.

An evidence-based approach to perioperative care : Update for the primary care physician. / O'Leary, Kevin J.; Arron, Martin J.; Lefevre, Frank; Chadha, Vinky; Lawrence Cohn, Steven.

In: Journal of Clinical Outcomes Management, Vol. 11, No. 6, 06.2004, p. 351-366.

Research output: Contribution to journalArticle

O'Leary, KJ, Arron, MJ, Lefevre, F, Chadha, V & Lawrence Cohn, S 2004, 'An evidence-based approach to perioperative care: Update for the primary care physician', Journal of Clinical Outcomes Management, vol. 11, no. 6, pp. 351-366.
O'Leary KJ, Arron MJ, Lefevre F, Chadha V, Lawrence Cohn S. An evidence-based approach to perioperative care: Update for the primary care physician. Journal of Clinical Outcomes Management. 2004 Jun;11(6):351-366.
O'Leary, Kevin J. ; Arron, Martin J. ; Lefevre, Frank ; Chadha, Vinky ; Lawrence Cohn, Steven. / An evidence-based approach to perioperative care : Update for the primary care physician. In: Journal of Clinical Outcomes Management. 2004 ; Vol. 11, No. 6. pp. 351-366.
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