HOUSTON – (July 23, 2014) – Anesthesiologists at The University of Texas Health Science Center at Houston (UTHealth) Medical School are taking personalized medicine into the Pre-Operative Anesthesia Clinic at Memorial Hermann-Texas Medical Center.
“We have a surgical home model that goes across pre-surgical, surgical and post-surgical care,” said Davide Cattano, M.D., Ph.D., associate professor of anesthesiology and medical director of the clinic. “We are the mediators between their physicians and surgeons. We make risk assessments based on the type of surgery and patient factors. We analyze their medications and can personalize how long to take them off medications before surgery.”
The goal of the surgical home model is to minimize potential complications, maintain safe medical practice, improve outcomes, decrease costs and optimize the patient’s health status before scheduled surgery.
Research led by Cattano in the UTHealth Medical School’s Department of Anesthesiology, has centered around patients who are on antiplatelet medications as a result of cardiac surgery. One study examined the optimal time to remove patients from antiplatelet therapy prior to surgery and they discovered that some patients don’t react as well to antiplatelet drugs such as clopidogrel and aspirin. Those patients may need to be left on their medications longer before surgery.
“It’s important to give as much of a drug as a patient needs instead of blanket guidelines, and to know when it is safe to proceed with surgery or other invasive procedures while avoiding bleeding complications,” Cattano said.
Pre-existing conditions such as diabetes can greatly affect surgical outcomes. Studies have shown that patients with diabetes do not do as well after surgery and the inflammatory response can affect the bowels, kidneys and lungs. These patients must be monitored closely, Cattano said.
Other studies, including one at UTHealth, have shown that there is a 30 percent reduction in pulmonary function for bariatric surgery patients because the morbidly obese have a reduction in their expiratory capacity and because surgery itself, including laparoscopy, is a source of pulmonary dysfunction.
As part of their perioperative assessment, anesthesiologists at the clinic now screen for obstructive sleep apnea.
“We did a study and screened 3,000 patients. Of those, 12 percent scored high risk for severe sleep apnea,” he said. “Fifty percent of all of our patients are obese, which places them at a higher risk for obstructive sleep apnea,” Cattano said. “When you have both obstructive sleep apnea and obesity, respiratory management becomes critical and the prevention of postoperative hypoxemia and other related complications are one of our top priorities.”
The clinic team also has been working toward reducing the surgical cancellation rate due to a patient’s decline in health and record reconciliations. “Higher levels of screening and communication have made a difference. Cancellations are down from 4 percent to less than 2 percent,” Cattano said. “We do a phone assessment at the time of scheduling so we have a medical history and can rate their health status.”
Cattano also created a dedicated survey for capturing one of the most important factors in patients’ quality of care – their satisfaction – and the team is working on improving the experience for patients and their families. More than 300 patients returned the latest review and 97 percent were highly satisfied.
Deborah Mann Lake
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