The Role of General Surgery Consultations in Patient Management

Divino Plastic Surgery Blog by Dr. Carlos Chacon

January 18, 2023

Surgery

The role of general surgery consultations in patient management can vary based on the physician. The type of patient, surgical procedure, and time of year can influence the physician’s decision to consult. In some instances, it’s a wise choice to seek the opinions of specialists in a particular field before having surgery.

Surgical residents had difficulty distinguishing dermatitis/eczema from dermatitis/eczema.

Dermatitis and eczema are inflammatory skin conditions. Patients with these diseases often require inpatient care. Some patients also require treatment in the operating room. These patients may have ulcers or wounds that need repair. Surgical residents have difficulty distinguishing dermatology and general surgery consultations. 

Dermatitis and eczema were the most common skin diseases in hospitalized patients. They were identified as the most frequent reason for preoperative and postoperative dermatology consultations. The authors hypothesized that the length of stay for these skin diseases was due to an initial diagnostic error.

A written evaluation form was used to evaluate the performance of surgical residents. It included consideration of medical knowledge, interpersonal skills, professionalism, and system-based practice.

Residents were asked to discuss patients with a senior surgical resident. This allowed them to discuss their history, physical findings, and treatment plan. As a result, residents developed their diagnostic testing strategies and differential diagnoses.

Perioperative medical consultations were more likely to have diabetes, vascular disease, or chronic renal failure.

Surgical patients with diabetes are at increased risk for postoperative complications, especially if they have diabetes or an underlying chronic condition. Perioperative management of these patients has been shown to reduce the likelihood of adverse clinical outcomes. It is essential to establish a customized perioperative approach to optimize glycemic control.

In addition to addressing glycemic control, a comprehensive preoperative evaluation process is needed to evaluate the patient’s health status. This includes an assessment of fluid homeostasis, electrolyte balance, and cardiovascular stability. Medications used to treat diabetes must be reviewed for their effects on these aspects of patient care.

Surgical patients with chronic kidney disease are at an elevated risk of postoperative complications. Patients with CKD are often elderly and may have multiple co-morbidities, including hypertension. They are at risk for a variety of acute and life-threatening complications.

Acute kidney injury is associated with a higher rate of mortality. Additionally, it is associated with substantial long-term morbidity and increased hospitalizations.

Common reasons for postoperative consultations

For many patients undergoing general outpatient surgery, a preoperative consultation may not be in their best interest. It may be an opportunity to get to know the surgeon better, but the surgeon will likely not have time to conduct a thorough medical evaluation. A preoperative consultation allows the surgeon to focus on the surgical procedure, freeing up valuable time for the other things that matter.

A recent study analyzed the preoperative consultations of a large population of low-risk surgery patients.The study identified 13,673 patients.

Researchers analyzed the most common preoperative and postoperative procedures. They found that some of the most common were:

The top reasons for consultation were evaluating the incision, wound healing, assessing a comorbid disease, and advising intraoperative advice. In addition, there were some minor differences by surgical specialty.

Benefits of electronic consultation systems

Electronic consultation systems are an emerging method of specialty care delivery. These secure Web-based platforms facilitate communication between primary care providers and specialists. They are designed to improve access to and coordination of specialty care.

Electronic consultations offer a safe, cost-effective way for patients to receive timely specialty care. While they are a viable alternative to face-to-face consultations, the ultimate clinical outcomes remain unclear. This literature review focuses on implementing electronic consultation systems across four healthcare delivery systems.

Several healthcare systems have implemented e-consults, including the Department of Veterans Affairs (VA) and Mayo Clinic. However, these programs have not yet achieved widespread use in the United States. Some barriers may prevent further growth.

The VA Ann Arbor Healthcare System (VAACS) analyzed the benefits of a systemwide electronic consultation program. Its findings include improved specialty care, lower costs, and more satisfied patients.