2023-05-16 07:35:57
Internal medicine doctors play “a key role” in pre-surgical optimization and in the post-operative period. up to 75% of readmissions after surgery are due to medical and non-surgical reasons
Anemia is present in one third of patients who undergo surgery
Anemia is present in a third of patients who are going to undergo surgery and, in another third, iron deficiency (lack of iron in the body) is present, which “is its precursor in most cases”
The approach to perioperative anemia consists of preventing it (or correcting it if it is already present) with the administration of iron sufficiently in advance so that the patient overcomes the anemia and arrives at surgery in the best possible conditions, with the internist having a key role in this optimization pre-surgery and post-surgery
Respiratory complications, together with infectious ones, are the most frequent in the postoperative period, even more than cardiac complications. Of these, the most frequent are respiratory failure and pneumonia. His prognosis, although generally good, can be dire. In fact, its 30-day mortality is higher than that of cardiac diseases
Vascular prosthesis infections “are rare, but serious for the patient and difficult to manage.” On the other hand, infections in joint prostheses, although also infrequent (they occur in 2% of implanted prostheses), do not usually entail vital risk, but they do impair quality of life and are also a complex approach.
Internal medicine doctors from all over the country have gathered in Madrid at the VII Shared Care and Hospital Medicine Meeting of the Spanish Society of Internal Medicine (SEMI), where they have analyzed developments in this field with a focus on the “fundamental and increasingly relevant” of the specialist in Internal Medicine in the optimization of patients before surgery and in post-surgical follow-up, as well as in the so-called “Rapid Recovery or ERAS” programs, taking into account the “high burden of comorbidity that patients present surgical patients today.
Said optimization carried out by internists, in the words of Dr. Eduardo Montero, coordinator of the SEMI Shared Assistance and Hospital Medicine Working Group, is key because it “reduces surgery suspensions, hospital stays and mortality, among other benefits. Likewise, the role of the internist in post-surgical follow-up is also highlighted to detect and treat complications that may appear early, including post-discharge follow-up of surgical patients, since it also reduces mortality and readmissions”. It is estimated that up to three quarters (75%) of patient readmissions after surgery are due to medical and non-surgical complications.
At said meeting, held on May 11 and 12, among other relevant topics, there was a lecture on “the latest developments in the management of perioperative anemia, a very important topic and in constant debate today. As stated, precisely, “anemia is present in a third of the patients who are going to undergo surgery, and in another third, iron deficiency (lack of iron in the body) is present, which is its precursor in most cases.” cases”. Its approach currently consists of preventing it, or correcting it if it is already present, through the administration of iron sufficiently in advance so that the patient overcomes the anemia and reaches the surgical intervention in the best possible conditions.
In relation to vascular prostheses, the management of infections related to this type of prosthesis has been addressed, which “although they are rare, are very serious for the patient and difficult to manage”, in addition to treating the impact of “the viral infections, especially COVID-19, in the perioperative period”.
Respiratory complications are among the most frequent complications after surgery. As mentioned, “this type of complications are, together with the infectious ones, the most frequent in the postoperative period, even more than the cardiac ones”. Of these, the most frequent are respiratory failure and pneumonia. His prognosis, although generally good, can be dire. In fact, “its 30-day mortality is higher than that of cardiac complications.”
The meeting was inaugurated by the Secretary General of SEMI, Dr. Manuel Méndez Bailón, and by Dr. Eduardo Montero Ruiz, as coordinator of the Shared Assistance and Hospital Medicine Group of SEMI.
Another of the issues discussed at the meeting was that of infections in joint prostheses. It has been mentioned that “they are rare, since they occur in around 2% of implanted prostheses. Although they do not pose a vital risk to the patient, they greatly reduce their quality of life and are complicated to treat, although it depends on each case.” “. In these cases, an attempt is made to “avoid removing the prosthesis placed by administering antibiotics for long periods of time”, but it is not always possible and, sometimes, “it must be removed”.
Programas “Rapid Recovery” o “ERAS”
The “Rapid Recovery” or “ERAS” programs are based on adequate preparation of patients before surgery. For this reason, the intervention of internists is essential in this optimization prior to surgery, among other reasons due to “the significant burden of comorbidity they have”, as indicated by Dr. Montero. After surgery “it is also important to monitor those patients who are considered especially necessary”, the same as with patients who are discharged from Internal Medicine services, since three quarters of the readmissions of operated patients It occurs for medical, not surgical, reasons.
Traumatology is one of the services with which assistance is most frequently performed shared with Internal Medicine, “obtaining very good results”. In this seventh edition of the meeting, special prominence has been given to resident doctors, in order to instill in them, from the residence, the growing importance of shared care and interconsultation for the benefit of patients.
hospital medicine
During the meeting, Hospitalist Medicine was also discussed. Hospital Medicine is a comprehensive, integrated and personalized care model, with a management system based on processes focused on patients, especially those with high needs, aimed at reducing risks and increasing clinical safety, incorporating aspects sociosanitary, and in connection with extrahospital medicine.
The structure of the services does not change, but rather their operation, forming multidisciplinary teams led by the hospital internist and practicing co-working, that is, the responsibility and accountability shared by all the professionals involved to obtain the best results in Health, incorporating the patients perspective.
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