What's Up Periop?-Slides

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This perioperative medicine update reviews recent key studies relevant to hospitalists managing surgical patients.<br /><br />A machine learning model developed at UPMC predicted 30-day postoperative mortality and major adverse cardiac and cerebrovascular events (MACCE) with high accuracy using only electronic medical record data, outperforming traditional ACS-NSQIP models. However, it requires external validation.<br /><br />SGLT2 inhibitors, commonly held preoperatively due to risk of euglycemic ketoacidosis, showed a significant association between the duration of hold time pre-surgery and degree of postoperative anion gap acidosis, especially in emergency surgeries, supporting adherence to holding recommendations.<br /><br />Increased postoperative mobilization was associated with a 25% reduction in composite complications including MI, stroke, VTE, and lower length of stay. Despite some confounding risks due to observational design, promoting early mobilization remains an actionable ERAS component.<br /><br />A retrospective study of older patients receiving low-to-moderate dose oral antipsychotics for presumed postoperative delirium found no difference in adverse events between typical and atypical antipsychotics, suggesting nonpharmacologic interventions should be prioritized.<br /><br />The SPACE randomized trial showed no significant benefit in withholding renin-angiotensin system inhibitors before elective non-cardiac surgery in reducing myocardial injury or major cardiac events but found increased hypertensive events when held. Further research is needed.<br /><br />Postoperative administration of coffee in patients after bowel resection reduced time to first flatus and length of stay compared to warm water, potentially offering a simple intervention to aid bowel recovery.<br /><br />The PREHAB trial demonstrated that a supervised 4-week multimodal prehabilitation program before colorectal cancer surgery reduced severe postoperative complications and improved functional recovery, though results were limited by early termination and lack of blinding.<br /><br />Cannabis use disorder was associated with a modest increase in perioperative complications and higher hospital costs in elective noncardiac surgery, though limitations include potential underreporting and lack of product specifics.<br /><br />The MET-REPAIR and NT-proBNP studies found that while self-reported functional capacity and NT-proBNP levels are independently associated with postoperative major adverse cardiac events, adding these measures to clinical risk scores modestly improves risk prediction and should be applied cautiously.<br /><br />Overall, these studies highlight advances in perioperative risk stratification, the importance of modifiable factors such as mobilization and prehabilitation, and the need for cautious interpretation of biomarkers and medication management strategies in surgical patients.
Keywords
perioperative medicine
machine learning
postoperative mortality
SGLT2 inhibitors
early mobilization
postoperative delirium
renin-angiotensin system inhibitors
postoperative coffee administration
prehabilitation
cannabis use disorder