Perioperative Management of Patients for Cardiac Procedures and Surgeries

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Geralyn Warfield (host): I’d like to welcome our audience today where we’re going to be discussing perioperative management of cardiac patients. And we have with us today, Jane Linderbaum. Jane, could you introduce yourself to our audience please?  

Jane Linderbaum (guest): Thanks, Geralyn. I’m Jane Linderbaum. I’m a Nurse Practitioner from Mayo Clinic in Rochester, Minnesota. 

My topic to for today’s [2024 Cardiovascular Nursing] symposium session is the management of cardiac patients undergoing cardiac procedures and surgeries.  

Oftentimes we hear a lot about patients undergoing non-cardiac procedures and surgeries. But when you think about our audience and patients that we see every day, most of our patients undergo cardiac procedures and surgeries. So, it’s important that we optimize management for those patients. 

Geralyn Warfield (host): So, could you expound a little bit [00:01:00] more for us why that perioperative management is important in our practice?  

Jane Linderbaum (guest): That’s a fantastic question, and I think it’s a question that comes to us in cardiology practices across the country every single day. 

So, it’s something we need. It’s something we need to know how to do well and efficient. And certainly, it impacts our overall patient safety and effectiveness for our surgical teams and our medical teams.  

We know that when we can optimize care for patients preoperatively, it decreases their surgical risk and complication risk. 

And certainly, when patients are optimized prior to arriving for their surgery or procedure, it minimizes rescheduling and delay of important procedures that patients need.  

And certainly, as we look at system overall efficiencies, it’s really great if we’re not unexpectedly rescheduling procedures for patients and busy practices. So, lots of good reasons we need to take great care of these patients in advance of their procedures and surgeries.  

Geralyn Warfield (host): I really appreciate you talking about the importance [00:02:00] of that kind of longitudinal view… 

Jane Linderbaum (guest): Yes.  

Geralyn Warfield (host): …of the importance of making that management important from the get-go so that all the way through their treatment and beyond it makes a huge difference, doesn’t it? 

Jane Linderbaum (guest): It certainly does, and patients really want to do the right thing. They certainly want things to go without complications as well.  

One of the roles we can really play is making sure patients understand why certain medications or drugs are stopped before a procedure, and when they should resume them so that we’re decreasing and optimizing their benefit of the surgical intervention, and certainly minimizing their risk of anything untoward happening during the surgery or in the perioperative period. 

Geralyn Warfield (host): So specifically, when we think about anticoagulation therapy, could you discuss a little bit more for us how a clinician might balance the risk and benefit of stopping that, when it comes to a thrombotic event possibility?  

Jane Linderbaum (guest): Right. Great example. It’s always a balance, of course. We want to decrease the risk of a thrombotic event, and certainly keep the risk of bleeding [00:03:00] low. 

Patients often come in very worried about having a stroke or a clot or a thrombotic event, and surgeons and medical professionals., we certainly don’t want to have to deal with a bleeding complication that may impact the effectiveness of the procedure of the surgery.  

But as we look at how to balance that, we want to look at each patient’s individual risk and make decisions based on that, based on a risk calculator, and making sure that we’re optimizing care for those patients.  

So, the short answer is it needs to be individualized for each patient based on the exact type of surgery or procedure they’re going for, and that patient’s individual risk. So, it’s important to look at both sides of it. 

Geralyn Warfield (host): Great. We’re going to take a quick break, and we will be right back.  

 

Geralyn Warfield (host): And we’re back, discussing perioperative management of patients. And one of the things that I would like us to talk just a little bit further about is, as patients are prepping for these kinds of events, for these kinds of procedures, how do you explain all of [00:04:00] the nuances of what’s going to be happening to them so that it’s clear, so that it’s effective, and so that they hear and understand? 

Jane Linderbaum (guest): Great. That’s the million-dollar question. And certainly, we want to give patients really a verbal overview, hopefully with a family member present, but more importantly, a written guidance on exactly what they need to do step by step.  

To do that well at the point of care or in discussion with the patient, we need to go over their medications. 

The patient’s medication list is important, but it’s also important to really facilitate and have a discussion with that patient on any other medications, therapies, supplements that they might be on, that in fact don’t ever make it to their medication list. And they’re really important.  

Most supplements certainly we want to hold before procedures and surgeries. 

And as we look at balancing anticoagulants, we need to give them specific stop days and dose. So, in other words, we need to tell them you’re stopping after your evening dose on the exact date prior to the surgery. [00:05:00]  

If they have questions, we definitely want to make sure that they’ve got a resource person to speak with. Because certainly we’re instructing these patients sometimes weeks or months before the actual scheduled elective surgery or procedure. 

So nonetheless, we want to go through it in detail and give them very clear written instructions with the resource.  

Geralyn Warfield (host): Is there one key takeaway from our conversation today that you would like to leave our listeners with?  

Jane Linderbaum (guest): I think that as we look at optimizing patients for surgery, and I use the word ‘optimizing’ rather than ‘clear.’ So, I think we can’t really say we can clear a patient for surgery, although that’s the common lingo, but what we want to do is optimize their medical therapy while minimizing their surgical, thrombotic, and bleed risk. 

So, we are medically optimizing patients for cardiac procedures and surgeries, and that’s how I would include it in my note.  

Geralyn Warfield (host): Thank you so very much for spending time with us today, Jane Linderbaum.  

Jane Linderbaum (guest): My pleasure, Geralyn, my pleasure.  

Geralyn Warfield (host): It’s been great talking with you. And this is your host, Geralyn Warfield, and we will see you next time. 

Jane Linderbaum (guest): Thank you. [00:06:00]  

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