More than 100 million surgical procedures are performed each year in the United States, including major surgeries and minor surgical procedures in both inpatient and outpatient setting. The advancements in surgical technique, instrumentation, intensive care units, and better anesthesia options, made the surgery safer today than it has ever been.
However, even the most minor procedure carries with it some degree of risk. Patients could develop an infection, they may have an allergic reaction to one of the prescribed medications, or they may have a condition that could affect the recovery or outcome.
Patients undergoing surgery turn to their primary care physician or cardiologist for a pre-operative evaluation, which is common practice in primary care, internal medicine, and anesthesiology. The purpose of this evaluation is to determine if the patients are healthy enough to undergo an operation. Also, surgeons would provide patients with paperwork asking for clearance from their physicians before the surgery.
However, making the decision on whether or not a patient is "safe" to proceed to the operating room is common in medical practice, but it's certainly not so simple; at least not without clear guidelines.
We already reviewed the app Surgical Outcome Risk Tool that predicts the 30-day mortality from surgery, based on a number of variables including the type of surgery, surgery severity, physical status, an age of a patient, etc.
The app we review today deals with the similar problem of pre-operative evaluation. PreOpGuide is a free mobile app for medical providers designed to help ensure patients are properly prepared for surgery, as well as to reduce or eliminate unnecessary pre-operative testing, minimize surgical delays and cancellations, and reduce costs for both patients and hospitals.
The app does this by providing an evidence-based, pre-operative anesthesia guide for medical providers who order or administer pre-operative testing.
Upon opening the app, you'll notice that the app's interface is basically made as a simple and easy to follow questionnaire, asking providers questions about the patient's surgical procedure and current medical condition(s).
First, you'd have to provide basic information about the patient including age and gender. Next, you need to answer questions about possible medical conditions, which are arranged by body systems, including pulmonary, cardiovascular, endocrinology, gastrointestinal, hematology/oncology, nephrology, and neurology.
These are followed by additional questions that address social history, i.e. alcohol and/or drug abuse, medication history, and finally the type of surgery, including the procedure complexity (minor or major). Beside Yes and No choices, there are "info" icons that provide more information to help clarify each question.
Once you're done with entering all information, you can click on the "submit" button, allowing the app to generate a pre-op plan for the specific patient. The plan provides details on what pre-op tests should be ordered, as well as whether or not a more robust cardiac clearance is required. While PreOpGuide app provides a list of the recommended tests necessary prior to surgery, it doesn't link to them or provides more information about these tests.
For the purpose of this review, I've evaluated a 66-year old female patient with a history of diabetes, and on anticoagulant therapy. She's scheduled for a hysterectomy, which is a procedure with major complexity.
After submitting all information, the app recommended several tests, including prothrombin time, type and screen (T&S), hemoglobin A1c, CBC, ECG and basic metabolic panel (BMP). The app gives you an option to print out these results or start the next pre-op evaluation. There's no option to share or save the report, which would be very useful.
The next patient was a 53-year old male with no medical history, who was scheduled for joint aspiration (a minor procedure). The app suggested two pre-op tests, urinalysis with reflex to culture and basic metabolic panel.
From what I saw, PreOpGuide app is a straightforward and easy to use clinical support tool, helping providers "clear" their patients and properly prepare them for surgery.
The developers claim that the app uses evidence-based guidelines for its recommendations, however, there's no clear statement anywhere in the app. Moreover, the app doesn't provide any links to resources, so I'm not sure what evidence-based guidelines the app has been based upon.
Hopefully, this is a thing that could be easily fixed in one of the future updates. Until then, PreOpGuide is nice, easy to use tool to perform the pre-op evaluation at the point of care that is still missing an important part to be considered a serious evidence-based tool.
Benefit: Clinicians, anesthesiologists, surgeons, general practitioners, emergency medicine physicians and physician assistants may benefit from this app.