Joan M Irizarry Alvarado

Mayo Clinic | MAYO · Department of Internal Medicine

Objectives: Hyperglycemia and increased preoperative hemoglobin A1c (HbA1c) are associated with perioperative morbidity and death. For nonurgent operations, adequate glycemic control before surgery is recommended. Our surgical practice needed a process for preoperative diabetes mellitus (DM) diagnosis and glycemic optimization. Methods: Our revi...

Background A previous study, using administrative data, reported an incidence of perioperative anaphylaxis (POA) of 1:6537 procedures in the United States. Objective We sought to determine the incidence of POA in a prospective US cohort. Methods Adult participants undergoing a procedure at a single tertiary care center were studied prospectively...

Objective : Routine medical testing is not recommended before cataract surgery, but no consensus exists about preoperative testing before general ophthalmologic surgery. We aimed to assess the impact of preoperative testing on patients undergoing ophthalmologic surgery by analyzing their surgical outcomes and complications. Methods : We retrospect...

Objective: We aimed to review recommendations for the postoperative resumption of direct oral anticoagulants (DOACs) and report complications 30 days postoperatively. Methods: We retrospectively reviewed patients receiving DOAC therapy who underwent preoperative evaluations from January 1, 2015 through May 30, 2018. We noted days that DOAC thera...

Objective: To evaluate the association between the use of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) preoperatively with changes in estimated glomerular filtration rate (eGFR) after robotic-assisted partial nephrectomy (RAPN). Methods: Patients undergoing RAPN at our institution from February 2008 thr...

During the coronavirus disease 2019 (COVID-19) pandemic, the study institution recognized the importance of providing preoperative COVID-19 testing and symptom screening to ensure patient safety. A multidisciplinary quality improvement team used Define, Measure, Analyze, Improve, and Control methodology to understand the issues, identify solutions,...

Since the beginning of the COVID-19 pandemic, healthcare providers worldwide have faced many obstacles in the diagnostic evaluation of patients for severe acute respiratory syndrome coronavirus 2, the causative virus. Even with the application of statistical inference by Bayes’ theorem to estimate the probability of a diagnosis, with and without te...

Objective : Add to available understanding of COVID-19 to help decrease further spread of SARS-CoV-2 by providing protocol providers can consider when giving patients recommendations to retest as well as length of time for self-isolation. Methods : We retrospectively collected data from the electronic medical record of patients in the Mayo Clinic...

Objective To assess the impact of cessation of screening urine cultures on surgical site infection (SSI) incidence in clinical practice. Patients and Methods Our study included patients undergoing hip replacement, knee replacement, spinal fusion, and laminectomy 12 months before (preintervention) and after (postintervention) cessation of preoperat...

Purpose: Preoperative pain medicine consultations with opioid-tolerant patients allow for an accurate medication history, patient involvement in the postoperative plan, and realistic goal setting. The purpose of this quality improvement project was to increase attendance at preoperative pain consultations, thereby increasing patient satisfaction....

Background: Chronic urticaria/angioedema (CUA) guidelines recommend limiting tests to diagnose and assess prognosis, activity, and severity. Routine testing in CUA might substantially increase cost of disease without benefiting outcome. Objective: To evaluate the utility of tests in CUA and how they influence the cost of disease. Methods: We r...

In 2008, Mayo Clinic in Jacksonville, Florida, developed the preoperative evaluation (POE) clinic under the department of anesthesiology to provide preoperative history and physical examination, and medical optimization. Over time, the POE clinic expanded to accommodate more than 90% of surgical patients, outgrowing the initial practice model. The...

Introduction Perioperative anaphylaxis is infrequent with an incidence of 1 in 2,000 – 20,000 procedures. Alemtuzumab is a humanized anti-CD52 monoclonal antibody (mAb) used as an off-label anti-rejection therapy in renal transplantation. Case description A 60-year-old non-atopic African American male with end-stage renal disease (ESRD) secondary...

Introduction Food-dependent, exercise-induced anaphylaxis (FDEIAn) is characterized by anaphylaxis which occurs only after the patient exercises within hours of eating. This is a case of tomato-dependent, exercise-induced anaphylaxis. Figure. Reactions of Episodes 1 and 2. (Episode 1) Generalized urticaria and face angioedema of episode 1 and gener...

Background: No clear guideline exists for the management of female hormone therapy in the perioperative period. Besides oral contraceptives (OCPs), hormone medications have been prescribed to treat cancer, osteoporosis, and menopausal symptoms. Since the introduction of OCPs in the 1960s, the thromboembolic risk associated with these medications h...

Background: As the prevalence of hypertension continues to increase, physicians routinely encounter patients preoperatively receiving one or more cardiovascular medications to manage hypertension. Thus, the physician's knowledge of perioperative antihypertensive medication management is crucial to ensure patient safety. Objective: We discuss the...

Background: Antiarrhythmic medications are an important tool in preventing recurrence of intraoperative and postoperative arrhythmias. Objective: To review current literature and recommendations for perioperative management of antiarrhythmic medications. Methods: Literature review is presented along with the pharmacology of antiarrhythmics. R...

Background: The prevalence of anticoagulant use has increased in the United States. Medical providers have the responsibility to explain to patients the management of anticoagulant regimens before an invasive procedure. The pharmacologic characteristics of these medications-specifically, their half-lives-are important in timing an interruption of...

Background: Given the prevalence of diabetes mellitus in modern society, health care providers are frequently tasked with managing glucose control in the perioperative period. When determining perioperative diabetes management, the clinician must balance the need to maintain relative euglycemia at the time of surgery with preventing hypoglycemia o...

The goal of this project was to improve preoperative medication instructions. After baseline data were collected prospectively through standardised patient surveys, preoperative care providers were educated to convey clear, appropriate preoperative medication instructions. After the education period, patient surveys were again completed to assess i...

We report 3 cases of patients with HIV/AIDS in whom Fanconi syndrome and nephrogenic diabetes insipidus developed secondary to use of an antiretroviral regimen containing tenofovir disoproxil fumarate and didanosine. These patients presented with a history of polydipsia, polyuria, weight loss, anorexia, and wasting. Interestingly, 1 patient was not...

Staphylococcus schleiferi subspecies coagulans is a relatively recently described organism with limited human pathogenicity. Described case reports of infection are primarily limited to canine external otitis with only one reported case of human involvement, localized to a surgical wound infection. Similarities in phenotypic and microbiological cha...