Our Summary

This research paper talks about the practice of admitting patients on the day of their elective heart surgery, rather than having them in the hospital beforehand. This approach has several benefits, including medical, logistical, psychological, and financial. However, for this to be effective, a thorough outpatient pre-operation evaluation is crucial. The researchers argue that anesthesiologists can lead this process, reducing unnecessary hospital stays, excessive lab tests, and unneeded consultations. They also suggest that anesthesiologists can take the lead in creating a ‘peri-operative anesthesia/surgical home’, a concept that focuses on the entire period around the surgery, making the process smoother and more efficient for patients. The authors share their successful experience over the past eight years in setting up and running a same-day cardiac surgery clinic, hoping to guide other anesthesiologists to do the same.

FAQs

  1. What are the benefits of admitting patients on the day of their elective heart surgery?
  2. What is the role of anesthesiologists in the outpatient pre-operation evaluation process?
  3. What is a ‘peri-operative anesthesia/surgical home’ and how does it make the surgical process more efficient for patients?

Doctor’s Tip

One helpful tip a doctor might tell a patient about cardiac surgery is to follow all pre-operative instructions carefully, including fasting guidelines and medication instructions. It is important to be as healthy as possible before surgery to ensure the best possible outcome. Additionally, it is important to communicate openly with your healthcare team about any concerns or questions you may have leading up to the surgery.

Suitable For

Patients who are typically recommended for cardiac surgery include those with severe coronary artery disease, valvular heart disease, congenital heart defects, and heart failure. These patients may have symptoms such as chest pain, shortness of breath, fatigue, or palpitations, and may have already tried other treatments such as medication or lifestyle changes. Additionally, patients who have had a heart attack or who are at high risk for a heart attack may also be recommended for cardiac surgery. It is important for these patients to be thoroughly evaluated by a multidisciplinary team, including cardiologists, cardiac surgeons, anesthesiologists, and other healthcare providers, to determine the best course of treatment for their specific condition.

Timeline

Before cardiac surgery:

  • Patient is evaluated by a cardiologist and/or cardiac surgeon to determine the need for surgery
  • Patient undergoes pre-operative testing such as blood work, imaging studies, and cardiac catheterization
  • Patient may attend pre-operative education sessions to learn about the surgery and recovery process
  • Patient may meet with an anesthesiologist to discuss anesthesia options and address any concerns

Day of surgery:

  • Patient arrives at the hospital or surgical center and is admitted for surgery
  • Patient meets with the surgical team, including the surgeon and anesthesiologist, to review the surgical plan
  • Patient undergoes anesthesia and the surgery is performed
  • After surgery, the patient is transferred to the intensive care unit or recovery area for monitoring

After cardiac surgery:

  • Patient is closely monitored for any complications or side effects of the surgery
  • Patient begins physical therapy and rehabilitation to aid in recovery
  • Patient is discharged from the hospital once stable, typically within a few days to a week
  • Patient follows up with their cardiologist and surgeon for post-operative care and monitoring

Overall, the timeline for a patient before and after cardiac surgery involves thorough pre-operative evaluation, surgery, recovery, and post-operative care to ensure the best possible outcome for the patient.

What to Ask Your Doctor

  1. What is the specific type of cardiac surgery that I need, and why is it necessary?
  2. What are the potential risks and complications associated with this surgery?
  3. How long will the recovery process take, and what can I expect during this time?
  4. What is the success rate of this type of surgery, and what are the expected outcomes?
  5. Are there any alternative treatment options available for my condition?
  6. What kind of anesthesia will be used during the surgery, and what are the potential side effects?
  7. How experienced is the surgical team in performing this specific type of surgery?
  8. What kind of post-operative care will be provided, and how long will I need to stay in the hospital?
  9. Are there any lifestyle changes or medications that I will need to take after the surgery?
  10. How can I best prepare myself physically and mentally for the surgery and the recovery process?

Reference

Authors: Silvay G, Goldberg A, Gutsche JT, T Augoustides JG. Journal: J Anesth. 2016 Jun;30(3):444-8. doi: 10.1007/s00540-016-2139-8. Epub 2016 Feb 4. PMID: 26847740