Essential Keys To Managing The High-Risk Patient Undergoing Elective Surgery
- Volume 23 - Issue 9 - September 2010
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The successful outcome of elective surgery on a high-risk patient is based upon performing the proper procedure on a properly prepared patient at the proper time. A hastened review of a consent form and limited discussion of the expected postoperative recovery course could result in complications that proper informed consent could have avoided.
Preparing patients and their support network for what is expected of them postoperatively is essential to minimizing complications. Just like preparing for an exam in school, one obtains better results with a review of information over time as opposed to “cramming” the night before or walking into an exam cold and expecting to “wing it.” A patient will do better with adherence to postoperative weightbearing restrictions and will be more receptive to the necessity of postoperative skilled nursing or acute rehabilitation facility placement if one discusses these areas and addresses them preoperatively.
Ensuring sound procedure planning as well as operating room setup can help facilitate the procedure. Attention to detail should extend beyond the operating room and continue with proper postoperative dressing management and patient activity restrictions.
Implementing the aforementioned fundamental keys of success will become rote in your planning of elective surgery in the high-risk patient as the benefits will help facilitate better outcomes and fewer post-op complications.
Dr. Schade is the Acting Chief of the Limb Preservation Service, Vascular/Endovascular Surgery Service in the Department of Surgery at Madigan Army Medical Center in Tacoma, Wash. She is an Associate of the American College of Foot and Ankle Surgeons.
Dr. Steinberg is an Assistant Professor in the Department of Plastic Surgery at the Georgetown University School of Medicine in Washington, D.C. Dr. Steinberg is a Fellow of the American College of Foot and Ankle Surgeons.
1. Brenner LH, Brenner AL, Horowitz D. Beyond informed consent educating the patient. Clin Orthop Relat Res 2009; 467(2):328-351.
2. Easley ME. Medicolegal aspects of foot and ankle surgery. Clin Orthop Relat Res 2005; 433(4):77-81.
3. Roukis TS, Stapleton JJ, Zgonis T. Addressing psychosocial aspects of care for patients with diabetes undergoing limb salvage surgery. Clin Pod Med Surg 2007; 24(3):601-610.
4. Roukis TS, Zgonis T. Post-operative shoe modifications for weightbearing with the Ilizarov external fixation system. J Foot Ankle Surg 2004; 43(6):433-435.
5. Lehnert B, Jhala G. The use of foam as a postoperative compression dressing. J Foot Ankle Surg 2005; 44(1):68-69.
6. Schweinberger MH, Roukis TS. Wound complications. Clin Pod Med Surg 2009; 26(1):1-10.
7. Schade VL, Roukis TS. Use of a surgical preparation and sterile dressing change during office visit treatment of chronic foot and ankle wounds decreases the incident of infection and treatment costs. Foot Ankle Specialist 2008; 1(3): 147-154.