Proceedings of the 3rd Annual Perioperative Medicine Summit

Supplement Co-Editors and Supplement Co-Directors:
Amir K. Jaffer, MD, and Franklin A. Michota, Jr., MD

Summit Co-Directors:
Angela M. Bader, MD, MPH, and Raymond Borkowski, MD

Contents

Forword: New topics, returning features, tools for enduring challenges
Amir K. Jaffer, MD, and Franklin A. Michota, Jr., MD

Summit Faculty

Summit Program

IMPACT Consults

Are routine preoperative chest radiographs necessary in asymptomatic patients undergoing noncardiothoracic surgery?
Anitha Rajamanickam, MD, Preethi Patel, MD, and Ali Usmani, MD

Do preoperative nutritional interventions improve outcomes in malnourished patients undergoing elective surgery?
Ramnath Hebbar, MD, and Brian Harte, MD

Do all patients undergoing bariatric surgery need polysomnography to evaluate for obstructive sleep apnea?
Roop Kaw, MD, Vesselin Dimov, MD, and Charles Bae, MD

Can brain natriuretic peptide identify noncardiac surgery patients at high risk for cardiac events?
Ali Usmani, MD, Priyanka Sharma, MD, and Ashish Aneja, MD

What is the significance of an isolated elevated activated partial thromboplastin time in the preoperative setting?
William H. Morris, MD, and Ajay Kumar, MD

Does unrecognized diabetes in the preoperative period worsen postoperative outcomes?
Krista Andersen-Harris, DO, and Christopher Whinney, MD

Should an asymptomatic patient with an abnormal urinalysis (bacteriuria or pyuria) be treated with antibiotics prior to major joint replacement surgery?
Anitha Rajamanickam, MD, Saira Noor, MD, and Ali Usmani, MD

Does a carotid bruit predict cerebrovascular complications following noncardiac surgery in asymptomatic patients?
Robert Mayock, MD

What risks does a history of pulmonary hypertension present for patients undergoing noncardiac surgery?
Roop Kaw, MD, Priyanka Sharma, MD, and Omar A. Minai, MD

Does a systolic murmur heard in the aortic area need to be further evaluated prior to elective surgery?
Thadeo Catacutan, MD, Ali Usmani, MD, and Ashish Aneja, MD

Abstracts

Oral Abstracts
Preoperative electrocardiograms: Patient factors predictive of abnormalities
Darin Correll, David Hepner, Lawrence Tsen, Candace Chang, Angela Bader

Impact of combination medical therapy on mortality in vascular surgery patients
Thomas Barrett, Motomi Mori, Caroline Koudelka

Do large electronic medical record databases permit collection of reliable and valid data for quality improvement purposes?
Ashish Aneja, Eric Hixson, Brian Harte, Vesselin Dimov, Amir Jaffer

Poster Abstracts
Innovations in Perioperative Medicine
Abstract 1: PONV: 'An ounce of prevention is worth a pound of cure'
Catherine Capitula, Shari Duguay

Abstract 2: Optimization of perioperative processes through innovation and technology for the orthopaedic operating room of the future
J.H. James Choi, Jennifer Blueter, Barbara Fahey, James Leonard, Ted Omilanowski, Vincent Riley, Mark Schauer, Timothy Sullivan, Viktor Krebs, Jonathan Schaffer

Abstract 3: A systematic approach to interpreting electrocardiograms by using two mnemonics
Vesselin Dimov, Kalina Uzunova-Dimova, Ajay Kumar, Ashish Aneja

Abstract 4: Improving and standardizing medicine consultation
Benny Gavi, Lisa Shieh, Keith Posley, Shahram Sepehri, Phil Pang

Abstract 5: Medical students' assessment of a required rotation in perioperative medicine and pain
Amir Jaffer, Samuel Irefin, John Tetzlaff, J. Harry Isaacson

Abstract 6: Improving safety for adult surgical patients with obstructive sleep apnea
Karen Watkins

Abstract 7: A multidisciplinary approach to improving the safety of high-risk spine surgery: The complex spine protocol
Peter Kallas, Anjali Desai, Andrew Naidech, Tyler Koski, Steve Ondra, Mary Lou Green

Abstract 8: The nurse practitioner role in evidence-based medication strategies
Patricia Kidik, Kathleen Holbrook

Abstract 9: Use of the motivator/hygiene theory of motivation to guide quality efforts
Ronald Kratz

Abstract 10: A novel care model coordinating inpatient and outpatient perioperative care, utilizing a computerized patient tracking system
Diane Levitan, Dominic Reilly, Christopher Wong, Kara Mitchell, Philip Vedovatti, Nason Hamlin

Abstract 11: The development of an admitting team
Kathleen McGrath, Janet Piatek, Jeanne Lanchester

Abstract 12: Improve communication among caregivers: Eliminating unauthorized abbreviations on hospital medical records
Magdalena G. Smith, Maura Walsh, Laurie Walsh, Marjorie Guglin, Dio Sumaygaysay, Evangelina Sapalasan, Frances Haug, Olivia Voellmicke, Mahin Sanjari, Nancy Cimitile, Mariya Chernyatskaya

Abstract 13: Improve preadmission testing process
Magdalena G. Smith, Tak Tam, Rita Medrozo, Maura Walsh, Laurie Walsh, Marjorie Guglin

Perioperative Clinical Vignettes
Abstract 14: Chronic renal insufficiency: An oft-forgotten component of the revised cardiac risk index
Vesselin Dimov, Ashish Aneja, Kalina Uzunova-Dimova

Abstract 15: When is a stress test indicated in patients with chronic kidney disease evaluated for noncardiac surgery?
Vesselin Dimov, Kalina Uzunova-Dimova, Mitko Badov, Saira Noor

Abstract 16: When to correct hyperkalemia in patients with chronic kidney disease prior to noncardiac surgery?
Vesselin Dimov, Kalina Uzunova-Dimova, Ajay Kumar, Anitha Rajamanickam, Mitko Badov

Abstract 17: What is the optimal time frame for performing hemodialysis in patients with end-stage renal disease prior to surgery?
Vesselin Dimov, Kalina Uzunova-Dimova, Mitko Badov, Ajay Kumar

Abstract 18: A recent vascular graft in a patient with end-stage renal disease on hemodialysis and the need for preoperative antibiotic prophylaxis
Vesselin Dimov, Kalina Uzunova-Dimova, Mitko Badov, Ajay Kumar

Abstract 19: Postoperative risk of acute kidney injury in patients with chronic kidney disease
Vesselin Dimov, Kalina Uzunova-Dimova, Ali Usmani, Ajay Kumar

Abstract 20: Preoperative hypoglycemia in a patient on detemir insulin
Ronad P. Olson, M. Angelyn Bethel, Lillian F. Lien

Abstract 21: Evaluation of Mobitz I atrioventricular block in a preoperative patient
Margaret Pothier

Abstract 22: Perioperative cardiac arrest in a patient with aortic stenosis: Is it preventable?
Zdravka Zafirova, Bobbie Sweitzer

Abstract 23: Antiplatelet therapy interruption and perioperative stent thrombosis: Too much, too early
Zdravka Zafirova, Bobbie Sweitzer

Research in Perioperative Medicine
Abstract 24: Use of an at-home internet-based patient evaluation tool for preoperative assessment
Margaret Pothier, David Hepner, Darrin Correll, Thomas Ho, Alina Lazar, Angela Bader

Abstract 25: The utility of a preoperative clinic questionnaire to predict postoperative delirium risk
David Hepner, Darin Correll, Thomas Ho, Juergen Bludau, Jhoanna Santos, Angela Bader

Abstract 26: A drug by any other name: Preoperative insulin regimens
Carlee Clark, Vivek Moitra, Bobbie Jean Sweitzer

Abstract 27: Preoperative cardiovascular risk factor assessment in morbidly obese patients with an abnormal electrocardiogram
Girish Mood, Roomana Akhtar, Rajagopal Reddy Edula, Gunjana Bhandari, Vishal Gupta, Michael Koch

Abstract 28: Cardiac testing prior to nonvascular surgery: The results from a newly formed preoperative clinic
Sheela Pai, Giang Tran, Alvin Blaustein, Prasad Atluri, Salwa Shenaq

Abstract 29: Which is better—half-dose or no insulin on day of surgery?
Kirk Smith, Vivek Moitra, Melinda Drum, Bobbie Jean Sweitzer

Index of Authors

Supplement Co-Editors and Supplement Co-Directors:
Amir K. Jaffer, MD, and Franklin A. Michota, Jr., MD

Summit Co-Directors:
Angela M. Bader, MD, MPH, and Raymond Borkowski, MD

Contents

Forword: New topics, returning features, tools for enduring challenges
Amir K. Jaffer, MD, and Franklin A. Michota, Jr., MD

Summit Faculty

Summit Program

IMPACT Consults

Are routine preoperative chest radiographs necessary in asymptomatic patients undergoing noncardiothoracic surgery?
Anitha Rajamanickam, MD, Preethi Patel, MD, and Ali Usmani, MD

Do preoperative nutritional interventions improve outcomes in malnourished patients undergoing elective surgery?
Ramnath Hebbar, MD, and Brian Harte, MD

Do all patients undergoing bariatric surgery need polysomnography to evaluate for obstructive sleep apnea?
Roop Kaw, MD, Vesselin Dimov, MD, and Charles Bae, MD

Can brain natriuretic peptide identify noncardiac surgery patients at high risk for cardiac events?
Ali Usmani, MD, Priyanka Sharma, MD, and Ashish Aneja, MD

What is the significance of an isolated elevated activated partial thromboplastin time in the preoperative setting?
William H. Morris, MD, and Ajay Kumar, MD

Does unrecognized diabetes in the preoperative period worsen postoperative outcomes?
Krista Andersen-Harris, DO, and Christopher Whinney, MD

Should an asymptomatic patient with an abnormal urinalysis (bacteriuria or pyuria) be treated with antibiotics prior to major joint replacement surgery?
Anitha Rajamanickam, MD, Saira Noor, MD, and Ali Usmani, MD

Does a carotid bruit predict cerebrovascular complications following noncardiac surgery in asymptomatic patients?
Robert Mayock, MD

What risks does a history of pulmonary hypertension present for patients undergoing noncardiac surgery?
Roop Kaw, MD, Priyanka Sharma, MD, and Omar A. Minai, MD

Does a systolic murmur heard in the aortic area need to be further evaluated prior to elective surgery?
Thadeo Catacutan, MD, Ali Usmani, MD, and Ashish Aneja, MD

Abstracts

Oral Abstracts
Preoperative electrocardiograms: Patient factors predictive of abnormalities
Darin Correll, David Hepner, Lawrence Tsen, Candace Chang, Angela Bader

Impact of combination medical therapy on mortality in vascular surgery patients
Thomas Barrett, Motomi Mori, Caroline Koudelka

Do large electronic medical record databases permit collection of reliable and valid data for quality improvement purposes?
Ashish Aneja, Eric Hixson, Brian Harte, Vesselin Dimov, Amir Jaffer

Poster Abstracts
Innovations in Perioperative Medicine
Abstract 1: PONV: 'An ounce of prevention is worth a pound of cure'
Catherine Capitula, Shari Duguay

Abstract 2: Optimization of perioperative processes through innovation and technology for the orthopaedic operating room of the future
J.H. James Choi, Jennifer Blueter, Barbara Fahey, James Leonard, Ted Omilanowski, Vincent Riley, Mark Schauer, Timothy Sullivan, Viktor Krebs, Jonathan Schaffer

Abstract 3: A systematic approach to interpreting electrocardiograms by using two mnemonics
Vesselin Dimov, Kalina Uzunova-Dimova, Ajay Kumar, Ashish Aneja

Abstract 4: Improving and standardizing medicine consultation
Benny Gavi, Lisa Shieh, Keith Posley, Shahram Sepehri, Phil Pang

Abstract 5: Medical students' assessment of a required rotation in perioperative medicine and pain
Amir Jaffer, Samuel Irefin, John Tetzlaff, J. Harry Isaacson

Abstract 6: Improving safety for adult surgical patients with obstructive sleep apnea
Karen Watkins

Abstract 7: A multidisciplinary approach to improving the safety of high-risk spine surgery: The complex spine protocol
Peter Kallas, Anjali Desai, Andrew Naidech, Tyler Koski, Steve Ondra, Mary Lou Green

Abstract 8: The nurse practitioner role in evidence-based medication strategies
Patricia Kidik, Kathleen Holbrook

Abstract 9: Use of the motivator/hygiene theory of motivation to guide quality efforts
Ronald Kratz

Abstract 10: A novel care model coordinating inpatient and outpatient perioperative care, utilizing a computerized patient tracking system
Diane Levitan, Dominic Reilly, Christopher Wong, Kara Mitchell, Philip Vedovatti, Nason Hamlin

Abstract 11: The development of an admitting team
Kathleen McGrath, Janet Piatek, Jeanne Lanchester

Abstract 12: Improve communication among caregivers: Eliminating unauthorized abbreviations on hospital medical records
Magdalena G. Smith, Maura Walsh, Laurie Walsh, Marjorie Guglin, Dio Sumaygaysay, Evangelina Sapalasan, Frances Haug, Olivia Voellmicke, Mahin Sanjari, Nancy Cimitile, Mariya Chernyatskaya

Abstract 13: Improve preadmission testing process
Magdalena G. Smith, Tak Tam, Rita Medrozo, Maura Walsh, Laurie Walsh, Marjorie Guglin

Perioperative Clinical Vignettes
Abstract 14: Chronic renal insufficiency: An oft-forgotten component of the revised cardiac risk index
Vesselin Dimov, Ashish Aneja, Kalina Uzunova-Dimova

Abstract 15: When is a stress test indicated in patients with chronic kidney disease evaluated for noncardiac surgery?
Vesselin Dimov, Kalina Uzunova-Dimova, Mitko Badov, Saira Noor

Abstract 16: When to correct hyperkalemia in patients with chronic kidney disease prior to noncardiac surgery?
Vesselin Dimov, Kalina Uzunova-Dimova, Ajay Kumar, Anitha Rajamanickam, Mitko Badov

Abstract 17: What is the optimal time frame for performing hemodialysis in patients with end-stage renal disease prior to surgery?
Vesselin Dimov, Kalina Uzunova-Dimova, Mitko Badov, Ajay Kumar

Abstract 18: A recent vascular graft in a patient with end-stage renal disease on hemodialysis and the need for preoperative antibiotic prophylaxis
Vesselin Dimov, Kalina Uzunova-Dimova, Mitko Badov, Ajay Kumar

Abstract 19: Postoperative risk of acute kidney injury in patients with chronic kidney disease
Vesselin Dimov, Kalina Uzunova-Dimova, Ali Usmani, Ajay Kumar

Abstract 20: Preoperative hypoglycemia in a patient on detemir insulin
Ronad P. Olson, M. Angelyn Bethel, Lillian F. Lien

Abstract 21: Evaluation of Mobitz I atrioventricular block in a preoperative patient
Margaret Pothier

Abstract 22: Perioperative cardiac arrest in a patient with aortic stenosis: Is it preventable?
Zdravka Zafirova, Bobbie Sweitzer

Abstract 23: Antiplatelet therapy interruption and perioperative stent thrombosis: Too much, too early
Zdravka Zafirova, Bobbie Sweitzer

Research in Perioperative Medicine
Abstract 24: Use of an at-home internet-based patient evaluation tool for preoperative assessment
Margaret Pothier, David Hepner, Darrin Correll, Thomas Ho, Alina Lazar, Angela Bader

Abstract 25: The utility of a preoperative clinic questionnaire to predict postoperative delirium risk
David Hepner, Darin Correll, Thomas Ho, Juergen Bludau, Jhoanna Santos, Angela Bader

Abstract 26: A drug by any other name: Preoperative insulin regimens
Carlee Clark, Vivek Moitra, Bobbie Jean Sweitzer

Abstract 27: Preoperative cardiovascular risk factor assessment in morbidly obese patients with an abnormal electrocardiogram
Girish Mood, Roomana Akhtar, Rajagopal Reddy Edula, Gunjana Bhandari, Vishal Gupta, Michael Koch

Abstract 28: Cardiac testing prior to nonvascular surgery: The results from a newly formed preoperative clinic
Sheela Pai, Giang Tran, Alvin Blaustein, Prasad Atluri, Salwa Shenaq

Abstract 29: Which is better—half-dose or no insulin on day of surgery?
Kirk Smith, Vivek Moitra, Melinda Drum, Bobbie Jean Sweitzer

Index of Authors

Supplement Co-Editors and Supplement Co-Directors:
Amir K. Jaffer, MD, and Franklin A. Michota, Jr., MD

Summit Co-Directors:
Angela M. Bader, MD, MPH, and Raymond Borkowski, MD

Contents

Forword: New topics, returning features, tools for enduring challenges
Amir K. Jaffer, MD, and Franklin A. Michota, Jr., MD

Summit Faculty

Summit Program

IMPACT Consults

Are routine preoperative chest radiographs necessary in asymptomatic patients undergoing noncardiothoracic surgery?
Anitha Rajamanickam, MD, Preethi Patel, MD, and Ali Usmani, MD

Do preoperative nutritional interventions improve outcomes in malnourished patients undergoing elective surgery?
Ramnath Hebbar, MD, and Brian Harte, MD

Do all patients undergoing bariatric surgery need polysomnography to evaluate for obstructive sleep apnea?
Roop Kaw, MD, Vesselin Dimov, MD, and Charles Bae, MD

Can brain natriuretic peptide identify noncardiac surgery patients at high risk for cardiac events?
Ali Usmani, MD, Priyanka Sharma, MD, and Ashish Aneja, MD

What is the significance of an isolated elevated activated partial thromboplastin time in the preoperative setting?
William H. Morris, MD, and Ajay Kumar, MD

Does unrecognized diabetes in the preoperative period worsen postoperative outcomes?
Krista Andersen-Harris, DO, and Christopher Whinney, MD

Should an asymptomatic patient with an abnormal urinalysis (bacteriuria or pyuria) be treated with antibiotics prior to major joint replacement surgery?
Anitha Rajamanickam, MD, Saira Noor, MD, and Ali Usmani, MD

Does a carotid bruit predict cerebrovascular complications following noncardiac surgery in asymptomatic patients?
Robert Mayock, MD

What risks does a history of pulmonary hypertension present for patients undergoing noncardiac surgery?
Roop Kaw, MD, Priyanka Sharma, MD, and Omar A. Minai, MD

Does a systolic murmur heard in the aortic area need to be further evaluated prior to elective surgery?
Thadeo Catacutan, MD, Ali Usmani, MD, and Ashish Aneja, MD

Abstracts

Oral Abstracts
Preoperative electrocardiograms: Patient factors predictive of abnormalities
Darin Correll, David Hepner, Lawrence Tsen, Candace Chang, Angela Bader

Impact of combination medical therapy on mortality in vascular surgery patients
Thomas Barrett, Motomi Mori, Caroline Koudelka

Do large electronic medical record databases permit collection of reliable and valid data for quality improvement purposes?
Ashish Aneja, Eric Hixson, Brian Harte, Vesselin Dimov, Amir Jaffer

Poster Abstracts
Innovations in Perioperative Medicine
Abstract 1: PONV: 'An ounce of prevention is worth a pound of cure'
Catherine Capitula, Shari Duguay

Abstract 2: Optimization of perioperative processes through innovation and technology for the orthopaedic operating room of the future
J.H. James Choi, Jennifer Blueter, Barbara Fahey, James Leonard, Ted Omilanowski, Vincent Riley, Mark Schauer, Timothy Sullivan, Viktor Krebs, Jonathan Schaffer

Abstract 3: A systematic approach to interpreting electrocardiograms by using two mnemonics
Vesselin Dimov, Kalina Uzunova-Dimova, Ajay Kumar, Ashish Aneja

Abstract 4: Improving and standardizing medicine consultation
Benny Gavi, Lisa Shieh, Keith Posley, Shahram Sepehri, Phil Pang

Abstract 5: Medical students' assessment of a required rotation in perioperative medicine and pain
Amir Jaffer, Samuel Irefin, John Tetzlaff, J. Harry Isaacson

Abstract 6: Improving safety for adult surgical patients with obstructive sleep apnea
Karen Watkins

Abstract 7: A multidisciplinary approach to improving the safety of high-risk spine surgery: The complex spine protocol
Peter Kallas, Anjali Desai, Andrew Naidech, Tyler Koski, Steve Ondra, Mary Lou Green

Abstract 8: The nurse practitioner role in evidence-based medication strategies
Patricia Kidik, Kathleen Holbrook

Abstract 9: Use of the motivator/hygiene theory of motivation to guide quality efforts
Ronald Kratz

Abstract 10: A novel care model coordinating inpatient and outpatient perioperative care, utilizing a computerized patient tracking system
Diane Levitan, Dominic Reilly, Christopher Wong, Kara Mitchell, Philip Vedovatti, Nason Hamlin

Abstract 11: The development of an admitting team
Kathleen McGrath, Janet Piatek, Jeanne Lanchester

Abstract 12: Improve communication among caregivers: Eliminating unauthorized abbreviations on hospital medical records
Magdalena G. Smith, Maura Walsh, Laurie Walsh, Marjorie Guglin, Dio Sumaygaysay, Evangelina Sapalasan, Frances Haug, Olivia Voellmicke, Mahin Sanjari, Nancy Cimitile, Mariya Chernyatskaya

Abstract 13: Improve preadmission testing process
Magdalena G. Smith, Tak Tam, Rita Medrozo, Maura Walsh, Laurie Walsh, Marjorie Guglin

Perioperative Clinical Vignettes
Abstract 14: Chronic renal insufficiency: An oft-forgotten component of the revised cardiac risk index
Vesselin Dimov, Ashish Aneja, Kalina Uzunova-Dimova

Abstract 15: When is a stress test indicated in patients with chronic kidney disease evaluated for noncardiac surgery?
Vesselin Dimov, Kalina Uzunova-Dimova, Mitko Badov, Saira Noor

Abstract 16: When to correct hyperkalemia in patients with chronic kidney disease prior to noncardiac surgery?
Vesselin Dimov, Kalina Uzunova-Dimova, Ajay Kumar, Anitha Rajamanickam, Mitko Badov

Abstract 17: What is the optimal time frame for performing hemodialysis in patients with end-stage renal disease prior to surgery?
Vesselin Dimov, Kalina Uzunova-Dimova, Mitko Badov, Ajay Kumar

Abstract 18: A recent vascular graft in a patient with end-stage renal disease on hemodialysis and the need for preoperative antibiotic prophylaxis
Vesselin Dimov, Kalina Uzunova-Dimova, Mitko Badov, Ajay Kumar

Abstract 19: Postoperative risk of acute kidney injury in patients with chronic kidney disease
Vesselin Dimov, Kalina Uzunova-Dimova, Ali Usmani, Ajay Kumar

Abstract 20: Preoperative hypoglycemia in a patient on detemir insulin
Ronad P. Olson, M. Angelyn Bethel, Lillian F. Lien

Abstract 21: Evaluation of Mobitz I atrioventricular block in a preoperative patient
Margaret Pothier

Abstract 22: Perioperative cardiac arrest in a patient with aortic stenosis: Is it preventable?
Zdravka Zafirova, Bobbie Sweitzer

Abstract 23: Antiplatelet therapy interruption and perioperative stent thrombosis: Too much, too early
Zdravka Zafirova, Bobbie Sweitzer

Research in Perioperative Medicine
Abstract 24: Use of an at-home internet-based patient evaluation tool for preoperative assessment
Margaret Pothier, David Hepner, Darrin Correll, Thomas Ho, Alina Lazar, Angela Bader

Abstract 25: The utility of a preoperative clinic questionnaire to predict postoperative delirium risk
David Hepner, Darin Correll, Thomas Ho, Juergen Bludau, Jhoanna Santos, Angela Bader

Abstract 26: A drug by any other name: Preoperative insulin regimens
Carlee Clark, Vivek Moitra, Bobbie Jean Sweitzer

Abstract 27: Preoperative cardiovascular risk factor assessment in morbidly obese patients with an abnormal electrocardiogram
Girish Mood, Roomana Akhtar, Rajagopal Reddy Edula, Gunjana Bhandari, Vishal Gupta, Michael Koch

Abstract 28: Cardiac testing prior to nonvascular surgery: The results from a newly formed preoperative clinic
Sheela Pai, Giang Tran, Alvin Blaustein, Prasad Atluri, Salwa Shenaq

Abstract 29: Which is better—half-dose or no insulin on day of surgery?
Kirk Smith, Vivek Moitra, Melinda Drum, Bobbie Jean Sweitzer

Index of Authors