A Cleveland Clinic pediatric hospitalist sees much room for improvement in the perioperative management of pediatric patients with medical complexities characterized by rare multisystem disease.
Moises Auron, MD, says that while such patients are frequently candidates for life-sustaining surgeries—often multiple surgeries—their risk for increased morbidity and mortality remains high. Cleveland Clinic notes that many of these patients “are faced with chronic respiratory failure, airway issues, feeding challenges, neurologic impairment, congenital heart disease or medical device dependence,” and that “even a relatively minor procedure can become high-risk if communication breaks down or planning begins too late.”
“We kept seeing the same problem across institutions. Children with medical complexity were coming to surgery with enormous physiologic risk, yet perioperative care often remained fragmented,” Dr. Auron told Cleveland Clinic Consult QD. “One team focused on the airway; another focused on nutrition; another worried about medications or postoperative disposition. Everyone worked hard, but the process itself could still feel disconnected.”
The disconnected multidisciplinary care that Dr. Auron describes can negatively impact outcomes and result in recurrent hospitalizations, at great expense.
Dr. Auron calls for more seamless perioperative management of these patients, but he tells Cleveland Clinic Consult QD that “workflow flaws can be a symptom of a larger system-level issue, even when the system works reasonably well for otherwise healthy patients.”
Looking to create a practical resource for clinicians who manage these types of patients, Dr. Auron, a member of the Society for Perioperative Assessment & Quality Improvement, has coedited an issue of the Pediatric Clinics journal titled Perioperative Management and Optimization of the Pediatric Patient with Complex Medical Needs with colleague Mirna Giordano, MD, of Columbia University.
Dr. Auron describes the publication as “not a textbook filled with theory. It’s a clinically grounded issue that brings pediatric hospitalists, anesthesiologists, surgeons, intensivists, subspecialists and perioperative teams into the same conversation.”
Access the full issue of the journal here , and read the full Cleveland Clinic Consult QD article about it here.
