Preop Eval

from Joshua Steinberg MD

Preop Eval organizes and presents much of the guidance that one needs in order to evaluate and prepare adult patients for non-cardiac surgery. It is based upon the guidelines on this topic from the American College of Cardiology, the European Society of Anaesthesiology, the American Society of Anesthesiologists, the Institute for Clinical Systems Improvement, the American College of Chest Physicians, and more (full references in the app). The app contains 1 algorithm and 3 resources: the cardiac evaluation algorithm, guidance on starting and stopping key medications in the perioperative period, guidance on timing of surgery after cardiac events, and guidance on preoperative testing. It also contains a review of preoperative evaluation mainly for students and residents.

The app addresses such common questions as:

• who needs bloodwork before surgery?
• who needs an EKG or a CXR?
• how do I handle patients on warfarin, clopidogrel, and DOAC's?
• which patients need adjustment of perioperative insulin and diabetic meds, and how?
• which active cardiac conditions preclude surgery?
• how long after MI or stent should a patient wait before surgery?
• are there adjustments to make on psych meds, rheumatologic meds, ACE's and ARB's?

This app is written and intended for practicing physicians like internists, family physicians, and hospitalists; for resident physician trainees; and for medical students. In addition to being a reference, the algorithm is written to be a teaching tool by not just delivering an answer, but instead walking a physician through the evaluation process so that one learns that process along the way. As an educator and clinician, I am interested in feedback and I would be grateful for guidance on improving the tool.