Session 1: Bariatric, Cardiac, and Ortho Surgery and ERAS

This session will provide review recent cardiac and orthopedic surgical publications that have high impact to change clinical practice. The pre-operative assessment and post-operative management of patients undergoing bariatric (metabolic) surgery will be reviewed. The role of implants in hip fracture will be reviewed and implants as the panacea for hip fracture will be discussed through review of implant trials. The optimal length of antibiotic therapy for prosthetic joint infection will be reviewed based on recent literature comparing duration of therapy. Enhanced recovery after surgery (ERAS) standardized care before, during and after surgery. This session will summarize the evidence to support ERAS recommendations. Panel discussions will discuss and debate strengths and drawbacks of perioperative nutritional support and of a broader adoption of left atrial appendage occlusion for the treatment of atrial fibrillation.

Objectives:

  1. Appraise and apply the latest evidence from the LAAOS III and Cardiac Vision Surgery trials to their practice.
  2. Advocate and recognize the fundamental issues of perioperative care in patients undergoing metabolic surgery.
  3. Compare and contrast the emerging metabolic surgery procedures, recognize the nuances of each procedure, and define patient and surgical factors that go into choosing a specific procedure.
  4. Assess and apply the results of HIP ATTACK 1 and its clinical implications and the examine the design of the HIP ATTACK 2 Trial
  5. Identify and describe the challenges in choosing duration of antibiotic therapy for prosthetic joint infections.
  6. Define and define ERAS and apply the evidence to their practice.
  7. Compare and contrast the benefits and challenges of perioperative nutritional support.
  8. Discuss and debate virtual care in cardiac and orthopedic surgery and apply it to their practice.

SESSION 1 EVALUATION


Session 2: Virtual Care and Remote Automated Monitoring (RAM) Technology

This session focuses on a very clinically relevant and topical subject of virtual care that has been broadly adopted during the pandemic for pragmatic reasons despite limited evidence comparing virtual and standard care. This session will discuss two important trials on virtual care for post-operative patients. It will also provide a guide to setting up perioperative physician and nursing programs and review obstacles and possible solutions to setting up successful clinical and research virtual programs. The patient and family perspective of virtual care will be shared and tips for patient and family engagement will be reviewed. A panel debate and discussion will explore the role of preoperative assessments and the pros and cons of implementing perioperative virtual care programs once clinical care is not impacted by the pandemic.

Objectives:

  1. Appraise and apply current evidence for remote automated monitoring virtual care post-operatively and apply it to their practice.
  2. Appraise and apply the results of the SMARTVIEW Trial to their clinical practice.
  3. Assess and discuss the results of the PVC RAM Trial and its relevance to clinical practice and opportunities to apply it to their practice.
  4. Identify and assess key aspects of virtual care and RAM in post discharge care and advocate and adopt its use in appropriate patients in their practice.
  5. Recognize clinical factors in virtual care that require escalation of care and appraise and recommend models developed to assist with managing escalations of care.
  6. Examine patient and family perspectives of participating in post surgical virtual care and advise for patient and family engagement in designing and trials and in applying evidence to practice.
  7. Discuss the benefits of pre-operative consults.
  8. Recognize and describe the role of AI and Machine learning in RAM virtual care post-operative programs.
  9. Assess the education challenges with teaching virtual care and RAM and encourage the development of teaching and learning strategies to enhance improved virtual care in their practices.
  10. Examine the cost effectiveness of virtual care and determine how to optimize virtual care nurses.

SESSION 2 EVALUATION


Session 3: Anesthesia and Perioperative Care & Postoperative Pain

This session will address feedback from prior congresses on intra-operative topics (hemodynamics and anesthesia options) and for perioperative pain management. Four highly impactful anesthesia trials on intra-operative fluid management of a restrictive versus a liberal strategy and post-operative complications, intra-operative dexamethasone and surgical site infections, anesthetic depth, and surgical compilations, and if an intra-operative positional therapy device vs sham in patients with positional OSA is effective. Strategies, including perioperative lidocaine, to prevent post-operative surgical pain will be reviewed.

Objectives:

  1. Appraise the RELIEF trial results and apply it to their practice.
  2. Appraise the PADDI trial results and apply it to their practice.
  3. Appraise the BALANCE trial results and apply it to their practice.
  4. Appraise the POSA trial results and apply it to their practice.
  5. Describe the challenges of post surgical pain
  6. List and assess the predictors for chronic surgical pain and formulate treatment plans for chronic surgical pain.
  7. Review and discussion of the evidence for perioperative systemic lidocaine in the management of peri-operative pain.
  8. Discuss and assess multi-modal analgesic treatment options for post-operative pain and how to incorporate into practice.
  9. Apply the latest evidence on intra-operative fluid management, depth of anesthesia and use of positional devices for positional OSA.

SESSION 3 EVALUATION


Session 4: Vascular and neurocognitive complications – Part I and Part II

Session 4 (Part I and Part II) will explore in detail perioperative atrial fibrillation and perioperative stroke and patent foramen ovale. The current recommendations on prevention of perioperative venous thrombosis and management of perioperative chronic anticoagulation will be reviewed. A debate on the balance between perioperative bleeding and venous thrombosis and panel discussions the AHA Scientific Statement on Myocardial Infarction After Non-Cardiac Surgery (MINS) will appraise the literature and advise on pros and cons of different decisions. The benefits and disadvantages of routine cardiology consults for MINS, role of routine post-operative troponin measurements and the prognostic value of perioperative cardiac biomarkers will be reviewed.

Objectives:

  1. Describe the relationship between PFO and perioperative stroke and, judge current treatment options for prevention of embolic stroke.
  2. Define perioperative atrial fibrillation and discuss strategies to prevent, diagnose and treat perioperative atrial fibrillation.
  3. Assess current recommendation on perioperative arterial venous thrombosis prophylaxis and perioperative anticoagulation bridging in noncardiac surgery and decide how to adopt the recommendations into their practice/.
  4. Identify and discuss the challenges between prevention of perioperative venous thrombosis and bleeding.
  5. Appraise and discuss the AHA scientific statement on MINS and assess how to incorporate the recommendations into their practice.
  6. Discuss the value of perioperative/cardiac consultation for MINS and examine how to select patients who may, or may not, need cardiac consultation.
  7. Discuss the role of perioperative biomarker measurement in low-risk patients based on clinical models for patients undergoing surgery.
  8. Examine the prognostic value of perioperative cardiac biomarkers and the benefit of beta blockers and ACEI/ARB.
  9. Apply the latest evidence on perioperative stroke and atrial fibrillation to their practice

SESSION 4 EVALUATION – PART I

SESSION 4 EVALUATION – PART II