[HSF] Timing of cardiac surgery

[Tea Acuff]

number #4 sums it up. It is easier to explain to patients what you want to do and thank the docs for their timely referral, and do what the patients "agrees with".

tea



----- Original Message ----
From: Ajit Damle <damle at cableone.net>
To: OpenHeart-L at lists.hsforum.com
Sent: Monday, April 21, 2008 6:03:58 PM
Subject: [HSF] Timing of cardiac surgery

Dear Members,



We continue to be plied upon "urgent" cases by our cardiologists. I note
this tendency particularly in the younger cardiologists, where every CABG
has become "urgent"; has to be "operated before the patient goes home".



We are formalizing some internal (non-binding) criteria. I would like the
opinion of members. It would be great if you can provide any literature
references, for or against, and also delineate your practices, both for
urgent CABGs and valves. Mind, this is not for real urgent patients with
unstable symptoms, but more for unstable cardiologists.



We plan to propose ( with all three of us cardiac surgeons on board
here...to prevent surgeon "shopping"): 



Following patients



1. All patients, particularly the ones with raised creatinine pre-op. ( the
renal injury may not be  evident till after 48 hours). There is some new
ruling with Medicare that post-op renal failure may not be reimbursed I some
circumstances.



2. Patients on clopidogrel



3. A drop pf Hb by 1.0 to 1.5 gms is seen commonly after cardiac cath. This
becomes important in patients who have lower red cell mass to begin with.



4. On the whole, patient do better when they come in electively than when
operated on during the same admission.



Thanks!



Ajit Damle



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