Avas Panel Mon

6 Questions
Avas Panel Mon

AVAS Panel Session on Modifiable Patient Factors, Monday, May 8, 2017

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Questions and Answers
  • 1. 
    THE FACTS: HOW SMOKING, POOR GLYCEMIC CONTROL, ETOH ABUSE, DRUGS IMPACT PERIOPERATIVE RISKS  Non-modifiable surgical risk factors predictive of mortality include all of the following EXCEPT:
    • A. 

      Older age

    • B. 

      Male gender

    • C. 

      History of congestive heart failure

    • D. 

      Open surgery (vs laparoscopic)

  • 2. 
    THE FACTS: HOW SMOKING, POOR GLYCEMIC CONTROL, ETOH ABUSE, DRUGS IMPACT PERIOPERATIVE RISKS All of the following are significant risk factors for postoperative pulmonary complications EXCEPT:
    • A. 

      Mild or moderate asthma

    • B. 

      Chronic obstructive pulmonary disease

    • C. 

      Age older than 60 years,

    • D. 

      American Society of Anesthesiologists (ASA) class of III or greater

  • 3. 
    PRO - RIGHT TO REFUSE SURGERY ON PATIENTS WHO DO NOT MODIFY BEHAVIOR FOR HIGH RISK SURGERYA large multicenter ACS-NSQIP cohort study of the postoperative effects of smoking in patients undergoing major operation demonstrated that current smokers have:
    • A. 

      No impact on cardiovascular events, no impact on respiratory complications, and no increase in mortality

    • B. 

      No impact on cardiovascular events, 2-fold increase in respiratory complications, and no increase in mortality

    • C. 

      A 4-fold increase in cardiovascular events, 2-fold increase in respiratory complications, and no increase in mortality

    • D. 

      A 4-fold increase in cardiovascular events, 2-fold increase in respiratory complications, and 20% increase in mortality

  • 4. 
    PRO - RIGHT TO REFUSE SURGERY ON PATIENTS WHO DO NOT MODIFY BEHAVIOR FOR HIGH RISK SURGERYWith a conservative population-based smoking prevalence estimated at 16% and assuming 2 million adult inpatient surgical procedures are performed each year, the annual excess postoperative health care costs associated with current smokers is:
    • A. 

      $10 M

    • B. 

      $100 M

    • C. 

      $1 B

    • D. 

      $10 B

  • 5. 
    IS IT OUR PLACE TO JUDGE/PLAY GOD?Which procedure would one reasonably refuse to perform in a patient with cancer:
    • A. 

      Whipple

    • B. 

      Esophageal Resection

    • C. 

      APR

    • D. 

      DIEP Flap

  • 6. 
    ETHICS OF SUCH DECISIONS73 year old Veteran with critical limb ischemia presents with tobacco dependence and absent femoral pulses. Your hospital is wary of mortalities due to a recent uptick in the observed to expected mortality ratio. The most appropriate next step is:
    • A. 

      To work this Veteran up for revascularization

    • B. 

      Tell him that smokers don't get operations at your VA

    • C. 

      That he'll probably die if he needs a big surgery and that if he wants something done then he should get an outside opinion for his care

    • D. 

      That smoking cessation alone is likely to cure his problems, but that he can come back if he wants after quitting smoking.