Ten Years Experiences With Preoperative Evaluation Clinic for Day Admission Cardiac and Major Vascular Surgical Patients: Model for “Perioperative Anesthesia and Surgical Home”
Abstract
Admission on the day of surgery for elective cardiac and noncardiac surgery is the prevalent practice in North America and Canada. This approach realizes medical, psychological and logistical benefits, and its success is predicated on an effective outpatient preoperative evaluation. The establishment of a highly functional preoperative clinic with a comprehensive set up and efficient logistical pathways is invaluable. This notion in recent years has included the entire perioperative period, and the concept of a perioperative anesthesia/surgical home (PASH) is gaining popularity. The anesthesiologists as perioperative physicians can organize and lead the entire process from the preoperative evaluation, through the hosptial discharge. The functions of the PASH include preoperative optimization of medical conditions and psychological preparation of the patients and their support system; the care in the operating room and intensive care unit; pain management; respiratory therapy; cardiac rehabilitation; and specialized nutrition. Along with oversight of the medical issues, the preoperative visit is an opportune time for counseling, clarification of expectations and discussion of research, as well as for utilization of various informatics systems to consolidate the pertinent information and distribute it to relevant health care providers. We review the scientific foundation and practical applications of a preoperative visit and share our experience with the development of the preoperative evaluation clinic, designed specifically for cardiac and major vascular patients scheduled for day admission surgery. The ultimate goal of preoperative evaluation clinic is to ensure a safe, efficient, and cost-effective perioperative care for patients undergoing a complex type of surgery.
Get full access to this article
View all access and purchase options for this article.
References
1. Guru V, Tu JV, Ethells E, et al. Relationship between preventability of death after coronary artery bypass graft surgery and all-cause risk-adjusted mortality rates. Circulation. 2008;117:2969-2979.
2. Kelava M, Robich M, Houghtaling PKL, et al. Hospitalization before surgery increasers risk for postoperative infections. J Thorac Cardiovasc Surg. 2014;148: 1615-1621.
3. Kain ZN, Fitch JC, Kirsch JR, Mets B, Pearl RG. Future of anesthesiology is perioperative medicine: a call for action. Anesthesiology. 2015;122:1192-1195.
4. Wig J. The current status of day care surgery—a review. Indian J Anaesth. 2005;49:459-466.
5. Lee JA. The anaesthetic out-patient clinic. Anaesthesia. 1949;4:169-174.
6. Corman HH, Hornick EJ, Kritchman M, Terestman N. Emotional reaction of surgical patients to hospitalization, anesthesia and surgery. Am J Surg. 1958;96:646-653.
7. Sieffer MB, Greifenstein FE. The emotional response of patients to surgery and anesthesia. Anesthesiology. 1961;21:502-507.
8. Egbert LD, Battit GE, Turndorf H, Beecher HK. The value of the preoperative visit by an anesthetist. A study of doctor-patient rapport. JAMA. 1963;185:553-555.
9. Ausset S, Bouazis H, Brosseau M, Kinirons B, Benhamou D. Improvement of information gained from the pre-anesthetic visit through a quality-assurance programme. Br J Anaesth. 2002;88:280-283.
10. Practice advisory for preanesthesia evaluation: an updated report by the American Society of Anesthesiologists Task Force on Preanesthesia Evaluation. Anesthesiology. 2012;116:522-538.
11. Kluger MT, Tam EJ, Coleman NA, Runciman WB, Bullock MF. Inadequate pre-operative evaluation and preparation: a review of 197 reports from Australian Incident Monitoring Study. Anaesthesia. 2000;55:1173-1178.
12. Roizen M. Preoperative evaluation. In: Miller R, ed. Anesthesia. New York, NY: Churchill Livingstone; 1994:827-882.
13. Mowat IR, Kelleher AA. Preoperative assessment for cardiac surgery. Anaesth Intensive Care Med. 2012;13:469-474.
14. Wahr JA, Prager RL, Abernathy JH, et al. Patient safety in the cardiac operating room: human factors and teamwork: a scientific statement from the American Heart Association. Circulation. 2013;128:1139-1169.
15. Flynn BC, dePerio M, Hughes E, Silvay G. The need for specialized preanesthesia clinics for day admission cardiac and major vascular surgery patients. Semin Cardiothorac Vasc Anesth. 2009;13:241-248.
16. Holt NF, Silverman DG, Prasad R, Dziura J, Ruskin K. Preanesthesia clinic, information management and operating room delays: results of a survey of practicing anesthesiologists. Anesth Analg. 2007;104:615-618.
17. Ferschl MB, Tung A, Sweitzer BJ, Huo D, Glick DB. Preoperative clinic visit reduce operating room cancellation and delays. Anesthesiology. 2005;103:855-859.
18. Cantlay KL, Baker S, Parry A, Danjoux G. The impact of a consultant anaesthetist let pre-operative assessment clinic on patients undergoing major vascular surgery. Anaesthesia. 2006;61:234-239.
19. Fischer SP. Development and effectiveness of an anesthesia preoperative evaluation clinic in a teaching hospital. Anesthesiology. 1996;85:196-206.
20. Wijeysundera DN, Austin PC, Beattie WS, Hux JF, Laupacis A. A population-based study of anesthesia consultation before major noncardiac surgery. Arch Intern Med. 2009;169:595-602.
21. Lee A, Hillman KM. Anesthesia preoperative evaluation clinic. Anesthesiology. 1997;86:260-263.
22. Vogt AW, Henson LC. Unindicated preoperative testing. ASA physical status and financial implications. J Clin Anesth. 1997;9:437-441.
23. Klopenstein CE, Forster A, VanGessel E. Anesthetic assessment in an outpatient consultation clinic reduces preoperartive anxiety. Can J Anaesth. 2000;47:511-515.
24. Hepner DI, Bader AM, Hurwitz S, Gustafson M, Tsen LC. Patient satisfaction with preoperative assessment in the preoperative assessment testing clinic. Anesth Analg. 2004;98:1099-1105.
25. Parker BM, Tetzalaff JE, Litaker DL, Maurer WG. Redefining the preoperative evaluation process and the role of the anesthesiologist. J Clin Anesth. 2000;12:350-356.
26. Filsoufi F, Rahmanian PB, Castillo JG, Chikwe J, Silvay G, Adams DH. Results and predictors of early and late outcomes of coronary artery bypass graft surgery in octogenarians. J Cardiothorac Vasc Anesth. 2007;21:784-792.
27. Ferrari R, Ford I, Greenlaw N, et al. Geographical variations in the prevalence and management of cardiovascular risk factors in outpatients with CAD: data from the contemporary CLARIFY registry. Eur J Prev Cardiol. 2015;22:1056-1065.
28. Mozaffarian D, Benjamin EJ, Go AS, et al. Heart disease and stroke statistics—2015 update. A report from the American Heart Association. Circulation. 2015;131:e29-e322.
29. Fleisher LA, Fleischmann KE, Auerbach AD, et al. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;64:e77-e137.
30. Nashef SAM, Roques F, Sharples LD, et al. EuroSCORE II. Eur J Cardiothorac Surg. 2012;41:734-745.
31. Billah B, Huq MM, Smith JA, et al. AusSCORE II in predicting 30-day mortality after isolated coronary artery bypass grafting in Australia and New Zealand. J Thorac Cardiovasc Surg. 2014;148:1850-1855.
32. Nilsson J, Algotsson L, Hoglund P, Luhrs C, Brandt J. Comparison of 19 pre-operative risk stratification models in open-heart surgery. Eur Heart J. 2006;27:867-874.
33. Holinski S, Jessen S, Neumann K, Konertz W. Predictive power and implication of EuroSCORE, EuroSCORE II and STS Score for isolated repeated aortic valve replacement. Ann Thorac Cardiovasc Surg. 2015;21:242-246.
34. Kuwaki K, Inaba H, Yamamoto T, et al. Performance of the EuroSCORE II and the Society of Thoracic Surgeons Score in patients undergoing aortic valve replacement for aortic stenosis. J Cardiovasc Surg. 2015;56:455-462.
35. Ranucci M, Castelvecchio S, Menicanti L, Frigiola A, Pelissero G. Risk of assessing mortality risk in elective cardiac operations: age, creatinine, ejection fraction, and the law of parsimony. Circulation. 2009;119:3053-3061.
36. Capodanno D, Barbanti M, Tamburino C, et al. A simple risk tool (the OBSERVANT score) for prediction of 30-day mortality after transcatheter aortic valve replacement. Am J Cardiol. 2014;113:1851-1858.
37. Emren ZY, Emren SV, Kılıçaslan B, et al. Evaluation of the prevalence of coronary artery disease in patients with valvular heart disease. J Cardiothorac Surg. 2014;9:153-157.
38. Kruczan DD, Silva NA, Pereira Bde B, Romão VA, Correa Filho WB, Morales FE. Coronary artery disease in patients with rheumatic and non-rheumatic valvular heart disease treated at a public hospital in Rio de Janeiro. Arq Bras Cardiol. 2008;90:197-203.
39. Tribouilloy CM, Enriquez-Sarano M, Schaff HV, et al. Excess mortality due to coronary artery disease after valve surgery. Secular trends in valvular regurgitation and effect of internal mammary artery bypass. Circulation. 1998;98(19 suppl):II108-115.
40. Litmathe J, Boeken U, Feindt P, Gams E. Concomitant CABG-procedures in elderly patients undergoing aortic valve replacement. An additional risk factor? Z Kardiol. 2003;92:947-952.
41. Grigioni F, Enriquez-Sarano M, Zehr KJ, Bailey KR, Tajik AJ. Ischemic mitral regurgitation: long-term outcome and prognostic implications with quantitative Doppler assessment. Circulation. 2001;103:1759-1764.
42. Grossi EA, Crooke GA, DiGiorgi PL, et al. Impact of moderate functional mitral insufficiency in patients undergoing surgical revascularization. Circulation. 2006;114:I573-I576.
43. Benedetto U, Melina G, Roscitano A, et al. Does combined mitral valve surgery improve survival when compared to revascularization alone in patients with ischemic mitral regurgitation? A meta-analysis on 2479 patients. J Cardiovasc Med (Hagerstown). 2009;10:109-114.
44. Topkara VK, Cheema FH, Kesavaramanujam S, et al. Coronary artery bypass grafting in patients with low ejection fraction. Circulation. 2005;112:I344-I350.
45. Nardi P, Pellegrino A, Scafuri A, et al. Long-term outcome of coronary artery bypass grafting in patients with left ventricular dysfunction. Ann Thorac Surg. 2009;87:1401-1408.
46. Filsoufi F, Rahmanian PB, Castillo JG, Chikwe J, Kini AS, Adams D. Results and predictors of early and late outcome of coronary artery bypass grafting in patients with severely depressed left ventricular function. Ann Thorac Surg. 2007;84:808-816.
47. Chikwe J, Croft LB, Goldstone AB, et al. Comparison of the results of aortic valve replacement with or without concomitant coronary artery bypass grafting in patients with left ventricular ejection fraction <30% versus patients with ejection fraction >30%. Am J Cardiol. 2009;104:1717-1721.
48. Kalavrouziotis D, Buth KJ, Vyas T, Ali IS. Preoperative atrial fibrillation decreases event-free survival following cardiac surgery. Eur J Cardiothorac Surg. 2009;36:293-299.
49. Saxena A, Dinh DT, Reid CM, Smith JA, Shardey GC, Newcomb AE. Does preoperative atrial fibrillation portend a poorer prognosis in patients undergoing isolated aortic valve replacement? A multicentre australian study. Can J Cardiol. 2013;29:697-703.
50. Al-Sarraf N, Thalib L, Hughes A, Tolan M, Young V, McGovern E. Effect of preoperative atrial fibrillation on postoperative outcome following cardiac surgery. Cardiol Res Pract. 2012;2012:272384.
51. Magee M, Herbert MA, Dewey TM, et al. Atrial fibrillation after coronary artery bypass grafting surgery: development of a predictive risk algorithm. Ann Thorac Surg. 2007;83:1707-1712.
52. Gillmann HJ, Meinders A, Grohennig A, et al. Perioperative levels and changes of high-sensitivity troponin T are associated with cardiovascular events in vascular surgery patients. Crit Care Med. 2014;42:1498-1506.
53. Aijaz B, Squires RW, Thomas RJ, Johnson BD, Allison TG. Predictive value of heart rate recovery and peak oxygen consumption for long-term mortality in patients with coronary heart disease. Am J Cardiol. 2009;103:1641-1646.
54. Methvin A, Georgiopoulou VV, Kalogeropoulos AP, et al. Usefulness of cardiac index and peak exercise oxygen consumption for determining priority for cardiac transplantation. Am J Cardiol. 2010;105:1353-1355.
55. Dhoble A, Sarano ME, Kopecky SL, Thomas RJ, Hayes CL, Allison TG. Safety of symptom-limited cardiopulmonary exercise testing in patients with aortic stenosis. Am J Med. 2012;125:704-708.
56. Mieres JH, Shaw LJ, Arai A, et al. Role of noninvasive testing in the clinical evaluation of women with suspected coronary artery disease: consensus statement from the Cardiac Imaging Committee, Council on Clinical Cardiology, and the Cardiovascular Imaging and Intervention Committee, Council on Cardiovascular Radiology and Intervention, American Heart Association. Circulation. 2005;111:682-696.
57. Aarnoudse WH, Botman KJ, Pijls NH. False-negative myocardial scintigraphy in balanced three-vessel disease, revealed by coronary pressure measurement. Int J Cardiovasc Intervent. 2003;5:67-71.
58. Berman DS, Kang X, Slomka BJ, et al. Underestimation of extent of ischemia by gated SPECT myocardial perfusion imaging in patients with left main coronary artery disease. J Nucl Cardiol. 2007;14:521-528.
59. Janne d’Othée B, Siebert U, Cury R, Jadvar H, Dunn EJ, Hoffmann U. A systematic review on diagnostic accuracy of CT-based detection of significant coronary artery disease. Eur J Radiol. 2008;65:449-461.
60. Sirineni GK, Stillman AE. Understanding the heart: CT and MRI for coronary heart disease. J Thorac Imaging. 2007;22:107-113.
61. Moss E, Puska JD, Thourani VJ, et al. Avoiding aortic clamping during coronary artery bypass grafting reduces postoperative stroke. J Thorac Cardiovasc Surg. 2015;149:175-180.
62. Merie C, Køber L, Olsen PS, Andersson C, Jensen JS, Torp-Pederson C. Risk of stroke after coronary artery bypass grafting: effect of age and comorbidities. Stroke. 2012;43:38-43.
63. Ngaage DL, Cowen ME, Griffin S, Guvendik L, Cale AR. Early neurological complications after coronary artery bypass grafting and valve surgery in octogenarians. Eur J Cardiothorac Surg. 2008;33:653-659.
64. Messe SR, Acker MA, Kasner SE, et al. Determining Neurologic Outcome From Valve Operations (DeNOVO) investigators. Stroke after aortic valve surgery: results from a prospective cohort. Circulation. 2014;129:2253-2261.
65. Newman MF, Kirchner JL, Phillips-Bute B, et al. Longitudinal assessment of neurocognitive function after coronary-artery bypass surgery. N Engl J Med. 2001;344:395-402.
66. Bucerius J, Gummert JF, Borger MA, et al. Stroke after cardiac surgery: a risk factor analysis of 16,184 consecutive adult patients. Ann Thorac Surg. 2003;75:472-478.
67. Silbert BS, Scott DA, Evered LA, Lewis MS, Maruff PT. Preexisting cognitive impairment in patients scheduled for elective coronary artery bypass graft surgery. Anesth Analg. 2007;104:1023-1028.
68. Messerotti Benvenuti S, Patron E, Zanatta P, Polesel E, Palomba D. Preexisting cognitive status is associated with reduced behavioral functional capacity in patients 3 months after cardiac surgery: an extension study. Gen Hosp Psychiatry. 2014;36:368-374.
69. Patron E, Messerotti Benvenuti S, Zanatta P, Polesel E, Palomba D. Preexisting depressive symptoms are associated with long-term cognitive decline in patients after cardiac surgery. Gen Hosp Psychiatry. 2013;35:472-479.
70. Rothenhäusler HB, Grieser B, Nollert G, Reichart B, Schelling G, Kapfhammer HP. Psychiatric and psychosocial outcome of cardiac surgery with cardiopulmonary bypass: a prospective 12-month follow-up study. Gen Hosp Psychiatry. 2005;27:18-28.
71. Rosenberger P, Shernan SK, Löffler M, et al. The influence of epiaortic ultrasonography on intraoperative surgical management in 6051 cardiac surgical patients. Ann Thorac Surg. 2008;85:548-553.
72. Barber PA, Hach S, Tippett L, Ross L, Merry AF, Milsom P. Cerebral ischemic lesions on diffusion-weighted imaging are associated with neurocognitive decline after cardiac surgery. Stroke. 2008;39:1427-1433.
73. Phillips-Bute B, Mathew JP, Blumenthal JA, et al. Association of neurocognitive function and quality of life 1 year after coronary artery bypass graft (CABG) surgery. Psychosom Med. 2006;68:369-375.
74. Filsoufi F, Rahmanian PB, Castillo JG, Chikwe J, Adams DH. Predictors and early and late outcomes of respiratory failure in contemporary cardiac surgery. Chest. 2008;133:713-721.
75. Filsoufi F, Rahmanian PB, Castillo JG, Chikwe J, Adams DH. Logistic risk model predicting postoperative respiratory failure in patients undergoing valve surgery. Eur J Cardiothorac Surg. 2008;34:953-959.
76. Ried M, Unger P, Puehler T, Haneya A, Schmid C, Diez C. Mild-to-moderate COPD as a risk factor for increased 30-day mortality in cardiac surgery. Thorac Cardiovasc Surg. 2010;58:387-391.
77. Saleh HZ, Mohan K, Shaw M, et al. Impact of chronic obstructive pulmonary disease severity on surgical outcomes in patients undergoing non-emergent coronary artery bypass grafting. Eur J Cardiothorac Surg. 2012;42:108-113.
78. Lizak MK, Nash E, Zakliczyński M, Sliwka J, Knapik P, Zembala M. Additional spirometry criteria predict postoperative complications after coronary artery bypass grafting (CABG) independently of concomitant chronic obstructive pulmonary disease: when is off-pump CABG more beneficial? Pol Arch Med Wewn. 2009;119:550-557.
79. McAllister DA, Wild SH, MacLay JD, et al. Forced expiratory volume in one second predicts length of stay and in-hospital mortality in patients undergoing cardiac surgery: a retrospective cohort study. PLoS One. 2013;8(5):e64565.
80. Hulzebos EH, Helders PJ, Favie NJ, De Bie RA, Brutel de la Riviere A, Van Meeteren NL. Preoperative intensive inspiratory muscle training to prevent postoperative pulmonary complications in high-risk patients undergoing CABG surgery: a randomized clinical trial. JAMA. 2006;296:1851-1857.
81. Shakouri SK, Salekzamani Y, Taghizadieh A, et al. Effect of respiratory rehabilitation before open cardiac surgery on respiratory function: a randomized clinical trial. Cardiovasc Thorac Res. 2015;7:13-17.
82. van Straten AH, Hamad MA, van Zundert AJ, Martens EJ, Schönberger JP, de Wolf AM. Preoperative hemoglobin level as a predictor of survival after coronary artery bypass grafting: a comparison with the matched general population. Circulation. 2009;120:118-125.
83. Karkouti K, Wijeysundera DN, Beattie WS. Risk associated with preoperative anemia in cardiac surgery: a multicenter cohort study. Circulation. 2008;117:478-484.
84. De Santo L, Romano G, Della Corte A, et al. Preoperative anemia in patients undergoing coronary artery bypass grafting predicts acute kidney injury. J Thorac Cardiovasc Surg. 2009;138:965-970.
85. Gupta PK, Sundaram A, Mactaggart JN, et al. Preoperative anemia is an independent predictor of postoperative mortality and adverse cardiac events in elderly patients undergoing elective vascular operations. Ann Surg. 2013;258:1096-1102.
86. Paone G, Likosky DS, Brewer R, et al. Transfusion of 1 and 2 units of red blood cells is associated with increased morbidity and mortality. Ann Thorac Surg. 2014;97:87-94.
87. Hopewell S, Omar O, Hyde C, Yu LM, Doree C, Murphy MF. A systematic review of the effect of red blood cell transfusion on mortality: evidence from large-scale observational studies published between 2006 and 2010. BMJ Open. 2013;3(5).
88. Chatterjee S, Wetterslev J, Sharma A, Lichstein E, Mukherjee D. Association of blood transfusion with increased mortality in myocardial infarction: a meta-analysis and diversity-adjusted study sequential analysis. JAMA Intern Med. 2013;173:132-139.
89. Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124:144-154.
90. Myers K, Hajek P, Hinds C, McRobbie H. Stopping smoking shortly before surgery and postoperative complications: a systematic review and meta-analysis. Arch Intern Med. 2011;171:983-989.
91. Pedavally S, Fugate J, Rabinstein A. Serotonin syndrome in the intensive care unit: clinical presentations and precipitating medications. Neurocrit Care. 2014;21:108-113.
92. Pfeiffer RF. Antiparkinsonian agents. Drug interactions of clinical significance. Drug Saf. 1996;14:343-354.
93. Wilson W, Taubert KA, Gewitz M, et al. Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation. 2007;116:1736-1754.
94. Bratel J, Kennergren C, Dernevik L, Hakeberg M. Treatment of oral infections prior to heart valve surgery does not improve long-term survival. Swed Dent J. 2011;35:49-55.
95. Smith MM, Barbara DW, Mauermann WJ, Viozzi CF, Dearani JA, Grim KJ. Morbidity and mortality associated with dental extraction before cardiac operation. Ann Thorac Surg. 2014;97:838-844.
96. Meyer U, Weingart D, Deng MC, Scheld HH, Joos U. Heart transplants—assessment of dental procedures. Clin Oral Investig. 1999;3:79-83.
97. Wu GH, Manzon S, Badovinac R, Woo SB. Oral health, dental treatment, and cardiac valve surgery outcomes. Spec Care Dentist. 2008;28:65-72.
98. Lam D, Wright K, Archer B. Is it safe to perform dental and cardiac valve surgeries concomitantly? J Oral Maxillofac Surg. 2013;71:1000-1004.
99. Montebugnoli L, Prati C. Circulatory dynamics during dental extractions in normal, cardiac and transplant patients. J Am Dent Assoc. 2002;133:468-472.
100. Blinder D, Manor Y, Martinowitz U, Taicher S. Dental extractions in patients maintained on oral anticoagulant therapy: comparison of INR value with occurrence of postoperative bleeding. Int J Oral Maxillofac Surg. 2001;30:518-521.
101. Yasny JS, Silvay G. The value of optimizing dentition before cardiac surgery. J Cardiothor Vasc Anesth. 2007;21:587-591.
102. Gandhi N, Silvay G. How important is dental clearance for elective open heart operation? Ann Thorac Surg. 2015;99:377.
103. Lynn-McHale D, Corsetti A, Brady-Avis E, Shaffer R, McGrory J, Rothenberger C. Preoperative ICU tours: are they helpful? Am J Crit Care. 1997;6:106-115.
104. Kain ZN, Vakharia S, Garson L, et al. The perioperative surgical home as a future perioperative practice model. Anesth Analg. 2014;118:1126-1130.
Cite article
Cite article
Cite article
OR
Download to reference manager
If you have citation software installed, you can download article citation data to the citation manager of your choice
Information, rights and permissions
Information
Published In
Article first published online: November 29, 2015
Issue published: June 2016
Keywords
PubMed: 26620138
Authors
Metrics and citations
Metrics
Journals metrics
This article was published in Seminars in Cardiothoracic and Vascular Anesthesia.
VIEW ALL JOURNAL METRICSArticle usage*
Total views and downloads: 656
*Article usage tracking started in December 2016
Articles citing this one
Receive email alerts when this article is cited
Web of Science: 11 view articles Opens in new tab
Crossref: 18
-
Predictive Role of Preoperative Nutritional Status on Early Postoperat...
-
Guidelines on perioperative optimization protocol for the adult patien...
-
Mastering the Best Practices: A Comprehensive Look at the European Gui...
-
Chirurgie ambulatoire en 2022 : faut-il encore un parcours patient déd...
-
Thoracic Aortic Aneurysm Resection
-
Pre-anesthetic clinic internship: new teaching method of pre-anesthesi...
-
The Current State of Combined Pediatric Anesthesiology–Critical Care P...
-
Preoperative Treatment of Malnutrition and Sarcopenia in Cardiac Surge...
-
Dental clearance and postoperative heart infections: Observations from...
-
2019 EACTS/EACTA/EBCP guidelines on cardiopulmonary bypass in adult ca...
-
2019 EACTS/EACTA/EBCP guidelines on cardiopulmonary bypass in adult ca...
-
2019 EACTS/EACTA/EBCP guidelines on cardiopulmonary bypass in adult ca...
-
The Adolescent Minor and Urgent Aortic Surgery: Challenges and Solutio...
-
Role of the anesthesiologist-intensivist outside the ICU
-
Defining Value-Based Care in Cardiac and Vascular Anesthesiology: The ...
-
Risk Assessment
-
Preoperative clinic: Non-essential cost or catalyst for process effici...
-
The problems of implementation of rehabilitation programs after corona...
Figures and tables
Figures & Media
Tables
View Options
Get access
Access options
If you have access to journal content via a personal subscription, university, library, employer or society, select from the options below:
loading institutional access options
Alternatively, view purchase options below:
Purchase 24 hour online access to view and download content.
Access journal content via a DeepDyve subscription or find out more about this option.
