As the patients we evaluate for surgery get ever sicker, we are always searching for better ways to assess a patient's health. Of course there are all sorts of expensive tests we can order to give us hard numbers and reassure us of our anesthetic plans. However in this age of cost cutting and insurance oversight, perhaps there are cheaper tests that will give us equivalent results.
A few years ago I wrote about an article in the ASA Newsletter that described a couple of bedside techniques to help decide if a patient is safe to undergo surgery. They both have the advantage of requiring nothing more than a blood pressure and a pulse. Nothing simpler or cheaper than that.
Now there is another simple test that can be performed quickly and cheaply in preop. Written up in the Wells blog of the New York Times, this new test was developed in Norway and rapidly assesses the oxygen delivery capacity of a patient. Oxygen delivery is one way of determining a patient's cardiovascular health and physiologic age. The researchers were able to whittle all the different physiologic measurements of their 5,000 test subjects down to a test with only seven questions that can reliably decide oxygen delivery. Three of the questions ask about the exercise habits of the subject. Other questions include sex of the person, age, waist size, and baseline pulse rate. After trying out this test, it seems that the quantity and quality of exercise made very little difference in my calculated physiologic age. Whether I worked out less than or greater than thirty minutes each time made no change in the final calculation. But varying my waist size or pulse rate made much more meaningful changes. This makes sense since most people can achieve a smaller waist size or slower heart rate by exercising regularly.
So next time you see a patient in preop who you want to delay a case to get one more test prior to clearance, try some of these simple and noninvasive methods. This may save the patient from another expense and prevent your reputation from taking a hit as the anesthesiologist who likes to cancel cases.
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