title: Ten Years Experiences With Preoperative Evaluation Clinic for Day Admission Cardiac and Major Vascular Surgical Patients: Model for "Perioperative Anesthesia and Surgical Home".
abstract: Admission on the day of surgery for elective cardiac and noncardiac surgery is the prevalent practice in North America and Canada. This approach realizes medical, psychological and logistical benefits, and its success is predicated on an effective outpatient preoperative evaluation. The establishment of a highly functional preoperative clinic with a comprehensive set up and efficient logistical pathways is invaluable. This notion in recent years has included the entire perioperative period, and the concept of a perioperative anesthesia/surgical home (PASH) is gaining popularity. The anesthesiologists as perioperative physicians can organize and lead the entire process from the preoperative evaluation, through the hosptial discharge. The functions of the PASH include preoperative optimization of medical conditions and psychological preparation of the patients and their support system; the care in the operating room and intensive care unit; pain management; respiratory therapy; cardiac rehabilitation; and specialized nutrition. Along with oversight of the medical issues, the preoperative visit is an opportune time for counseling, clarification of expectations and discussion of research, as well as for utilization of various informatics systems to consolidate the pertinent information and distribute it to relevant health care providers. We review the scientific foundation and practical applications of a preoperative visit and share our experience with the development of the preoperative evaluation clinic, designed specifically for cardiac and major vascular patients scheduled for day admission surgery. The ultimate goal of preoperative evaluation clinic is to ensure a safe, efficient, and cost-effective perioperative care for patients undergoing a complex type of surgery.
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, NY, USA george.silvay@mountsinai.org.
authors.forename: George
authors.initials: G
authors.lastname: Silvay
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Zdravka
authors.initials: Z
authors.lastname: Zafirova
mesh_terms: D000758:Anesthesia; D006348:Cardiac Surgical Procedures; D002318:Cardiovascular Diseases / Q000150:complications; D002493:Central Nervous System Diseases / Q000150:complications; D003362:Cost-Benefit Analysis; D003729:Dental Care; D006402:Hematologic Diseases / Q000150:complications; D006801:Humans; D008171:Lung Diseases / Q000150:complications; D019990:Perioperative Care; D014656:Vascular Surgical Procedures
keywords: day admission surgery; elective cardiac surgery; major vascular surgery; patient satisfaction; perioperative anesthesia and surgical home; preoperative evaluation; safety and outcomes