With the passage of the Affordable Care Act in 2010 and most provisions due to take effect in 2014, it’s reasonable to ask what MD Anderson is doing to prepare.
Fall 2013 : Internal Medicine Perioperative Assessment Center
Understanding complications in the midst of complexity
Sunil Sahai, M.D., addresses patients' comorbidities before surgery to ensure the best possible outcomes. Photo: Wyatt McSpadden
Sunil Sahai, M.D., has dedicated his career to assessing and improving patients’ chances of surviving surgery. He wants the patient’s surgical course to be free of as many avoidable hurdles as possible.
“The challenge has been that some patients suffer complications in the post-operative period because they have medical comorbidities that haven’t been addressed prior to the surgery,” says the associate professor in General Internal Medicine and director of MD Anderson’s Internal Medicine Perioperative Assessment Center (IMPAC).
The IMPAC clinic assesses a patient’s risk of complications for surgery — comorbidities often forgotten in the face of cancer’s complexities — and takes the necessary precautions before he or she gets on the operating table. This medical optimization of the patient before surgery is done systematically and based on evidence.
A service surgeons appreciate
“We frequently operate on patients who are considered high risk due to the complexity of their surgery, their medical risk factors, or both,” says Randal Weber, M.D., professor and chair of Head and Neck Surgery. “Poorly controlled or unrecognized medical conditions that are not appropriately managed preoperatively can lead to a poor outcome for the patient.
“Multidisciplinary care allows us to achieve optimum outcomes,” he adds. “We work closely with our colleagues from IMPAC, who thoroughly evaluate our patients before surgery.”
Jason Fleming, M.D., professor in Surgical Oncology and specialist in pancreatic cancer, agrees, “IMPAC has been an extremely valuable resource for determining risk and ensuring comorbidities are accounted for. Ultimately, it allows us to perform personalized, safe and effective surgery.”
Compiling each patient’s medical history
While Sahai is the only physician dedicated to the center, the other internists in the department rotate through; there are generally two physicians and an advanced practice nurse on duty each day.
The IMPAC service operates as a “center within the center,” staffed with two nurses and two patient services coordinators dedicated to the clinic. The IMPAC team searches records, contacts community doctors and puts together the most accurate and comprehensive medical history possible. Then, they coordinate medically complex patients with the surgery and anesthesia teams .
“We see about 20% to 25% of patients going for surgery or close to 6,000 patients a year,” Sahai says. “Some patients don’t need to be seen by us because they have few medical issues, and, in general, the better a patient’s physical condition, the better the potential for successful surgery without complications.
“The best news is that due to the time we can spend with patients before surgery, the less time they spend in the post-operative setting, dealing with medical complications that could have been avoided, allowing them time to heal and focus on their recovery from cancer,” he says.
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