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Case 6: Preoperative High-Risk Screening and Specialist Screening Tools in the Context of a Patient Presenting for Surgical Consultation for a Renal Mass

Learning Objectives
1. Describe the range of high-risk preoperative screening tolls for older adults being risk assessed prior to surgery
2. Recognize differences in care plans for high-risk patients
0.5 Credit CME

An 80-year-old woman is referred for surgical consultation after a solid renal mass is discovered incidentally while evaluating the cause of chronic abdominal pain. She presents alone without a family member. The patient has a history of hypertension, chronic atrial fibrillation, vitamin D deficiency, osteoporosis, and osteoarthritis. She has no history of previous surgery. Current medications include hydrochlorothiazide (25 mg daily), vitamin D3 (1000 IU daily), diltiazem (30 mg 4 times daily), calcium carbonate (500 mg 2 times daily), warfarin (2.5 mg at bedtime), and acetaminophen (500 mg 2 times daily). She lives alone at home and has an established advance directive. The patient uses a cane for ambulation and reports no falls. A review of systems survey completed on arrival is negative. Her temperature is 37°C (98.6°F), pulse is 90/min and irregular, respirations are 12/min, and blood pressure is 135/85 mm Hg. The patient is alert and oriented. Physical examination is noncontributory. Cardiac and pulmonary systems have been evaluated and were cleared by the primary care physician.

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Advisory Panel

The following members of the advisory panel had no relevant financial relationships with ineligible companies to disclose:

Ruben Azocar, MD

George Drach, MD

Sandhya Lagoo-Deenadayalan, MD, PhD

Andrew Lee, MD

Mike Malone MD

Myron Miller, MD

Arvind Nana, MD

Tom Robinson, MD

Victoria Tang MD, MAS

The following members of the advisory panel have reported relevant financial relationships with ineligible companies that have been mitigated through peer review of planning decisions by persons without relevant financial relationships and recusal from any aspect of planning and content related to the financial relationship:

Kevin Biese MD, MAT is a paid consultant for Call 9 Telemedicine Medical Advisor and Bristol Meyers Squibb/ Pfizer

Daniel Mendelson, MS, MD is a paid consultant for Point Click Care Touchscreen

Writing Panel

The following members of the writing panel had no relevant financial relationships with ineligible companies to disclose:

Tomas Griebling, MD

Joseph Hejkal, MD

Melissa Hornor, MD

Jason Johanning, MD

Sushila Murthy, MD, MPH

Tony Rosen, MD, MPH

Kate Schenning, MD, MPH

The following members of the writing panel have reported relevant financial relationships with ineligible companies that have been mitigated through peer review of content by persons without relevant financial relationships:

Charles Brown, MD is a paid consultant for and receives grants from Medtronic

Badrinath Konety, MD, MBA is a paid consultant for NxThera, and Bristol Myers Squibb, Opko and receives grant funding from Photocure, Genentech, and Genomic Health

Reviewers:

The following reviewers had no relevant financial relationships with ineligible companies to disclose:

Shamsuddin Akhtar, MD

Patrick Kortebein, MD

Joseph LoCicero, MD

Support Statement

This CME activity is supported by a grant from the John A. Hartford Foundation.

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References:
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