elective tubal ligation 4 weeks? 6 weeks?

[aneftp]

Just wondering what the "general consensus" here for "elective after the patient already goes home" time period for elective tubal ligation.

I canceled an elective tubal ligation on a patient 3 weeks post partum. I have always thought the general consensus was to wait roughly 6 weeks. Thought 3 weeks post partum was a little too soon for elective procedure (usual excuse for body to return to normal physiology state from pregnancy).

I know there is push from the "experts" in this politically charged environment the risks/benefits of getting pregnant again during this time period not to make the woman wait 6 weeks. Plus the whole medicaid 30 day wait period is another beast in itself for elective tubal ligation.

I've talked to my sister who is an OB and she even says 3 weeks is pushing it unless there is some over riding factor. My friends up north at super busy OB practices (lets just say they have 6-7 OB c/s going simultaneously even say the same thing).

I just can't find any written consensus. The ASA practice guidelines on OB anesthesia is pretty useless on this matter (the updated 2014 version) as it doesn't mention it.

I guess it up to each hospital practice to set their own policy.

---

Members don't see this ad.

 

[caligas]

Just wondering what the "general consensus" here for "elective after the patient already goes home" time period for elective tubal ligation.

I canceled an elective tubal ligation on a patient 3 weeks post partum. I have always thought the general consensus was to wait roughly 6 weeks. Thought 3 weeks post partum was a little too soon for elective procedure (usual excuse for body to return to normal physiology state from pregnancy).

I know there is push from the "experts" in this politically charged environment the risks/benefits of getting pregnant again during this time period not to make the woman wait 6 weeks. Plus the whole medicaid 30 day wait period is another beast in itself for elective tubal ligation.

I've talked to my sister who is an OB and she even says 3 weeks is pushing it unless there is some over riding factor. My friends up north at super busy OB practices (lets just say they have 6-7 OB c/s going simultaneously even say the same thing).

I just can't find any written consensus. The ASA practice guidelines on OB anesthesia is pretty useless on this matter (the updated 2014 version) as it doesn't mention it.

I guess it up to each hospital practice to set their own policy.

Just to play devils advocate: why does it matter that they have gone home, we do post partum tubals the next day with spinal.

 

[aneftp]

Just to play devils advocate: why does it matter that they have gone home, we do post partum tubals the next day with spinal.

I ain't talking about immediate post Partum period.

I am talking 3 weeks later. What is your group or hospital policy AFTER the patient gets discharged. And 3 weeks has passed.

U are talking about the immediate post Partum period still 1 day later. Because the time frame to get tubes tied while patient is still in hospital benefits/risk. Vs discharge and patient potentially not coming back at all.

 

[Arch Guillotti]

Just wondering what the "general consensus" here for "elective after the patient already goes home" time period for elective tubal ligation.

I canceled an elective tubal ligation on a patient 3 weeks post partum. I have always thought the general consensus was to wait roughly 6 weeks. Thought 3 weeks post partum was a little too soon for elective procedure (usual excuse for body to return to normal physiology state from pregnancy).

I know there is push from the "experts" in this politically charged environment the risks/benefits of getting pregnant again during this time period not to make the woman wait 6 weeks. Plus the whole medicaid 30 day wait period is another beast in itself for elective tubal ligation.

I've talked to my sister who is an OB and she even says 3 weeks is pushing it unless there is some over riding factor. My friends up north at super busy OB practices (lets just say they have 6-7 OB c/s going simultaneously even say the same thing).

I just can't find any written consensus. The ASA practice guidelines on OB anesthesia is pretty useless on this matter (the updated 2014 version) as it doesn't mention it.

I guess it up to each hospital practice to set their own policy.

What are you so concerned about?

IMHO this is a very weak cancellation.

 

[aneftp]

What are you so concerned about?

IMHO this is a very weak cancellation.

Obviously aspiration risk. Ain't a skinny patient.

Typical 5 2 280 pounder diabetic 3 weeks post Partum.

Physiologically women don't return to normal body state for around 5-6 weeks

ACOG is very vague on this matter. So is the ASA.

No one has answered my question. Which means you guys don't encounter this situation often

 

[deleted162650]

If you guys do PP BTLs when they are 1 day post-partum, then why would you cancel one 3 weeks later?? Physiology may not be 100% normal, but it's sure as hell more normal than it is 1 day after delivery.

P.S. Every PP BTL I've ever done has been under GA. After having 100% of in situ epidural caths fail to produce anything remotely close to an adequate level I just stopped trying to even bolus in the first place.

 

[aneftp]

If you guys do PP BTLs when they are 1 day post-partum, then why would you cancel one 3 weeks later?? Physiology may not be 100% normal, but it's sure as hell more normal than it is 1 day after delivery.

P.S. Every PP BTL I've ever done has been under GA. After having 100% of in situ epidural caths fail to produce anything remotely close to an adequate level I just stopped trying to even bolus in the first place.

Again. No one has answered my question. Cause not many people get exposed to patients coming in at 3 weeks post Partum.

The reason during it immediate post Partum 24-48 hours is simple (anatomically easier for OB) plus risk/benefits having in house (maybe indigent patient) who may not return for sterilization after pregnancy. Which makes it semi urgent procedure

 

[Arch Guillotti]

Which makes it semi urgent procedure

Very suspect reasoning. I think a tubal is elective 100% of the time.

 

[aneftp]

Very suspect reasoning. I think a tubal is elective 100% of the time.

So have u done it at 3 weeks?

I been arguing/texting with my big brother who's a anesthesiologist out in California all day on this matter. He says it's not a problem yet he's never done it at 3 weeks cause the Obs simply don't book them at 3 weeks electively.

 

[Planktonmd]

I honestly think that you are over thinking this one... If you are OK with 24 hours post-partum tubals then you should be OK with 2 weeks or 3 weeks or whatever!
That whole increased risk of aspiration thing is questionable and these women are not that different from your average morbidly obese patients.

 

[aneftp]

I honestly think that you are over thinking this one... If you are OK with 24 hours post-partum tubals then you should be OK with 2 weeks or 3 weeks or whatever!
That whole increased risk of aspiration thing is questionable and these women are not that different from your average morbidly obese patients.

Yes I agree over thinking. I obviously done much higher risk cases (MI patient for gallbladder 2 days later, active decompresated CHF etc)

But it seems to me no one (at least my friends or those one these message boards) has been in this exact situation.

So again. Who's done elective 3 weeks post partum tubal ligation? Most OBs simply don't book them this early.

 

[Hoya11]

Yes I agree over thinking. I obviously done much higher risk cases (MI patient for gallbladder 2 days later, active decompresated CHF etc)

But it seems to me no one (at least my friends or those one these message boards) has been in this exact situation.

So again. Who's done elective 3 weeks post partum tubal ligation? Most OBs simply don't book them this early.

I have. We probably all have we just don't think about it so much. I don't think I would cancel any case due to lingering changes of pregnancy still present x weeks later.

 

[Gas you down]

i haven't done any immediate postpartum btl's since residency.
I wouldn't do it at three weeks. it's obvious that it's atypical timing since you even asked the question. if something goes wrong, everyone will point to that.
defensive medicine sucks

 

[Ignatius J]

I am in the camp that doesn't see why you would do one one day later but then cancel three weeks later.

 

[Robotic Wis-Hipple]

Why not spinal her like you would your postpartums if you're concerned about aspiration/body habitus?

 

[aneftp]

Why not spinal her like you would your postpartums if you're concerned about aspiration/body habitus?

Have you taken your anesthesia oral boards?

That's gonna to get you down a slippery rope with the oral board examiners.

 

[aneftp]

I have. We probably all have we just don't think about it so much. I don't think I would cancel any case due to lingering changes of pregnancy still present x weeks later.

Are u in private practice? Or academics?

 

[aneftp]

The issue is say you have policies written like:

This 1,2,3 week post Partum elective stuff is all gray stuff area with ACOG and the ASA. There is no guide

Here an Army medical center policy

• Interval tubal ligation is perform at any time not associated with delivery of the baby.
• If you had just given birth and were unable to get your postpartum tubal ligation, you must wait at least 6-8 weeks as interval tubal ligation is very different than postpartum tubal ligation.

http://www.wbamc.amedd.army.mil/Dep...bstetrics/LaborAndDelivery/tuballigation.aspx

Here’s a private practice group OB policy stating 6 weeks wait for tubal ligation:
http://bellinghamobgyn.com/wp-

 

[Arch Guillotti]

The issue is say you have policies written like:

This 1,2,3 week post Partum elective stuff is all gray stuff area with ACOG and the ASA. There is no guide

Here an Army medical center policy

• Interval tubal ligation is perform at any time not associated with delivery of the baby.
• If you had just given birth and were unable to get your postpartum tubal ligation, you must wait at least 6-8 weeks as interval tubal ligation is very different than postpartum tubal ligation.

http://www.wbamc.amedd.army.mil/Dep...bstetrics/LaborAndDelivery/tuballigation.aspx

Here’s a private practice group OB policy stating 6 weeks wait for tubal ligation:
http://bellinghamobgyn.com/wp-

Who cares what the "policy" is for some random OB-GYN group?

 

[Robotic Wis-Hipple]

Have you taken your anesthesia oral boards?

That's gonna to get you down a slippery rope with the oral board examiners.

As would inducing. If your concern is the patient's body habitus and physiologic parameters not yet at baseline avoiding GA and airway manipulation may be the less concerning option. If the argument is that elective surgery should wait till 6 weeks postpartum yet you can find no consensus guidelines or practice guidelines of the sort I'd argue this is up to you, iirc I thought 2 weeks was recommended but I'll admit I haven't looked at the OB guidelines in over a year. This is what the orals are going to nail me on, the gray areas and my judgement. So, if body habitus and pregnancy related changes are concerning to me, assuming a non-laparoscopic approach, and steep trendelenderg won't be required I may argue a neuraxial approach provides the best risk/benefit ratio. If the balance favors GETA then I prepare for that with the appropriate equipment and backup plans in place as I'm not sure cancelling the case goes over well on the oral boards either.

But this is why I like what we do and this forum, something that initially sounds like a silly question turns out to be a gray area of debate and standard of care considerations.

 

[fakin' the funk]

Just wondering what the "general consensus" here for "elective after the patient already goes home" time period for elective tubal ligation.

I canceled an elective tubal ligation on a patient 3 weeks post partum. I have always thought the general consensus was to wait roughly 6 weeks. Thought 3 weeks post partum was a little too soon for elective procedure (usual excuse for body to return to normal physiology state from pregnancy).

No, we very rarely do PP BTLs anytime after 1-2 days postpartum. I don't think you'll find a "general consensus" on this because it seems rare.

I agree that to postpone based on "3 week postpartum physiology" when it's routinely done on "1 day postpartum physiology" is super weak. Why wouldn't you just spinal on the 3 weeker and be done with it, like you would on the 1 dayer?

 

[narcusprince]

Zu ze case!

 

[aneftp]

Who cares what the "policy" is for some random OB-GYN group?

Administrators care about their stupid "patient satisfaction scores" with case cancellations.

No policy in force means it's the Wild Wild West. Maybe they want it that way and push things to the limit.

 

[Urzuz]

100% agree that you're overthinking it. Your original question was what the general consensus is, and I would think the general consensus is to go ahead and do the case.

Defensive medicine is one thing, but you're literally trying to defend against something that inherently has a miniscule risk. This is in the same camp as cancelling a case if a patient sneezes while you're interviewing them. At a certain point, practicality must trump defensive medicine to make an OR move efficiently and for an anesthesia group to keep their contracts with a hospital...and to keep patients, surgeons, and your other partners happy!

 

[jwk]

Again. No one has answered my question. Cause not many people get exposed to patients coming in at 3 weeks post Partum.

The reason during it immediate post Partum 24-48 hours is simple (anatomically easier for OB) plus risk/benefits having in house (maybe indigent patient) who may not return for sterilization after pregnancy. Which makes it semi urgent procedure

Your anatomic reasoning is correct. The tubes are sitting right under the umbilicus post partum - not so 3-6 weeks out. That's why they're commonly done immediately post partum. If we know a patient is getting a PPTL, we leave the epidural in and make an attempt at dosing it for the tubal. Probably works 50-60% of the time, and if it doesn't work we just do a GA with RSI.

Otherwise, we wait 6 weeks, and those are done laparoscopically, not with a mini-lap like a PPTL.

 

[Ignatius J]

You can definitely tell who is salaried and who is productivity-based with these answers, lol.

 

[deleted171991]

Just to play devils advocate: why does it matter that they have gone home, we do post partum tubals the next day with spinal.

Same where I trained, 1-3 days postpartum.

 

[deleted171991]

Obviously aspiration risk. Ain't a skinny patient.

Typical 5 2 280 pounder diabetic 3 weeks post Partum.

Physiologically women don't return to normal body state for around 5-6 weeks

ACOG is very vague on this matter. So is the ASA.

No one has answered my question. Which means you guys don't encounter this situation often

Seriously, the main risk of aspiration is when a woman is in labor. Postpartum, if NPO, who cares?

 

[aneftp]

So why aren't Ob booking post partum tubal ligations 1-2-3 weeks routinely?

Thanks for everyone's input today. It's a minor nuisance to me. The OB was fine with me cancelling the case. He was surprised his office had booked the case to began with. It's the patient complaining to hospital administration about the cancellation. And hospital admin all about that patient satisfaction scoring.

I've got a lot of family members and very close friends in the anesthesia business and these were their responses:

Sister #1 6 weeks W2 hospital employee
Sister #2 6 weeks private practice/partner
Brother in law 6 weeks W2 hospital employee
Brother (he called me "weak"...ha ha) he said he'd do the case 1-2 weeks whatever/ partner/fee for service
Brother in law 6 weeks (academics)
first cousin (2-3 weeks is fine to do...."I don't care cause I let the OB fellows handle it) academics
(of note brother in law and cousin are both in the SAME EXACT ACADEMIC dept! up north)

Best friend in Texas (say's he'll do it anytime)/partner/fee for service
Best friend #2 (sold out to Mednax) now W2 employee: 6 weeks (one of the busiest OB hospitals in the country)

 

[IlDestriero]

This sounds like a great time for the old Prop/Sux/Tube.


--
Il Destriero

 

[deleted162650]

So, medically speaking what's the legitimate concern here? Putting "defensive medicine" aside what physiology are you honestly concerned about that makes it higher risk at 2wks vs 6wks? It's labor not pregnancy that delays gastric emptying, so as long as she's fasted I don't think she's any higher risk for aspiration.

 

[urge]

Just wondering what the "general consensus" here for "elective after the patient already goes home" time period for elective tubal ligation.

I canceled an elective tubal ligation on a patient 3 weeks post partum. I have always thought the general consensus was to wait roughly 6 weeks. Thought 3 weeks post partum was a little too soon for elective procedure (usual excuse for body to return to normal physiology state from pregnancy).

I know there is push from the "experts" in this politically charged environment the risks/benefits of getting pregnant again during this time period not to make the woman wait 6 weeks. Plus the whole medicaid 30 day wait period is another beast in itself for elective tubal ligation.

I've talked to my sister who is an OB and she even says 3 weeks is pushing it unless there is some over riding factor. My friends up north at super busy OB practices (lets just say they have 6-7 OB c/s going simultaneously even say the same thing).

I just can't find any written consensus. The ASA practice guidelines on OB anesthesia is pretty useless on this matter (the updated 2014 version) as it doesn't mention it.

I guess it up to each hospital practice to set their own policy.

Guess who is not making partner?

 

[Arch Guillotti]

I wouldn't do it at three weeks. it's obvious that it's atypical timing since you even asked the question. if something goes wrong, everyone will point to that.
defensive medicine sucks

Something could go wrong anytime with many cases that are done.

 

[Arch Guillotti]

Have you taken your anesthesia oral boards?

That's gonna to get you down a slippery rope with the oral board examiners.

This is not an oral board scenario. This is a simple case that you are making complicated. Your approach seems very dogmatic. My feeling is that there are a lot more important battles to fight than this one. Just do the case.

 

[BLADEMDA]

Tubal Ligation Any Other Time
If, for any reason, the tubal ligation can’t be arranged during your hospital stay, we can do it as soon as 4-6 weeks after delivery. Call Dr. Mackey’s office to arrange tubal ligation. The sooner a patient calls, the sooner we can get something arranged. We will then schedule a laparoscopic tubal ligation, instead of the postpartum tubal.

If, during your labor or hospitalization, you are having difficulty getting things arranged, contact Dr. Mackey, directly. It is expected that hospital staff and/or the patient can/should/will call, if there is trouble or confusion scheduling this surgery.

http://womens-health-center.org/contact/

 

[BLADEMDA]

Summary
No data indicate that the postpartum patient’s safety is enhanced by delaying surgery or is compromised by proceeding with surgery immediately after delivery. This situation has led to confusion and inconsistency in the development of policies for the performance of postpartum tubal ligation.33No waiting interval guarantees that the postpartum patient is free of risk for aspiration. It is probably prudent to use some form of aspiration prophylaxis in all patients undergoing postpartum tubal ligation. However, significant aspiration pneumonitis is so rare that it will be difficult to document cost-effectiveness and decreased rates of morbidity and mortality from the use of these measures. H2

http://clinicalgate.com/postpartum-tubal-sterilization/

 

[Planktonmd]

Tubal Ligation Any Other Time
If, for any reason, the tubal ligation can’t be arranged during your hospital stay, we can do it as soon as 4-6 weeks after delivery. Call Dr. Mackey’s office to arrange tubal ligation. The sooner a patient calls, the sooner we can get something arranged. We will then schedule a laparoscopic tubal ligation, instead of the postpartum tubal.

If, during your labor or hospitalization, you are having difficulty getting things arranged, contact Dr. Mackey, directly. It is expected that hospital staff and/or the patient can/should/will call, if there is trouble or confusion scheduling this surgery.

Who the F**K is Dr. Mackey???

 

[BLADEMDA]

http://www.frca.co.uk/Documents/185 Anaesthesia in pregnancy for non-obstetric surgery.pdf

This is worth your time. The authors recommend delaying elective surgery until 6 weeks postpartum. They do not provide any studies to back up that opinion.

 

[BLADEMDA]

Do you recommend breast feeding women discard their breast milk after a general anesthetic? If so, do you recommend just the first aliquot of Breast milk be discarded or the first two aliquots?

http://www.anesthesiaweb.org/breastfeeding.php

http://www.askdrsears.com/topics/fe...pecial-situations/breastfeeding-after-surgery

 

[BLADEMDA]

Effects on Lactation and Breastmilk


A randomized study compared the effects of cesarean section using general anesthesia, spinal anesthesia, or epidural anesthesia, to normal vaginal delivery on serum prolactin and oxytocin as well as time to initiation of lactation. General anesthesia was performed using propofol 2 mg/kg and rocuronium 0.6 mg/kg for induction, followed by sevoflurane and rocuronium 0.15 mg/kg as needed. Fentanyl 1 to 1.5 mcg/kg was administered after delivery. Patients in the general anesthesia group (n = 21) had higher post-procedure prolactin levels and a longer mean time to lactation initiation (25 hours) than in the other groups (10.8 to 11.8 hours). Postpartum oxytocin levels in the nonmedicated vaginal delivery group were higher than in the general and spinal anesthesia groups.[9]



Alternate Drugs to Consider


Etomidate, Methohexital, Midazolam, Thiopental



References


1. Vargo JJ, Delegge MH, Feld AD et al. Multisociety sedation curriculum for gastrointestinal endoscopy. Gastroenterology. 2012;143:e18-41. PMID: 22624720

2. Dailland P, Cockshott ID, Didier Lirzin J et al. Intravenous propofol during cesarean section: placental transfer, concentrations in breast milk, and neonatal effects. A preliminary study. Anesthesiology. 1989;71:827-34. PMID: 2589672

3. Nitsun M, Szokol JW, Saleh HJ, Murphy GS, Vender JS, Luong L et al. Pharmacokinetics of midazolam, propofol, and fentanyl transfer to human breast milk. Clin Pharmacol Ther. 2006;79:549-57. PMID: 16765143

4. Shergill AK, Ben-Menachem T, Chandrasekhara V et al. Guidelines for endoscopy in pregnant and lactating women. Gastrointest Endosc. 2012;76:18-24. PMID: 22579258

5. Bhaskara B, Dayananda VP, Kannan S et al. Effect of breastfeeding on haemodynamics and consumption of propofol and sevoflurane: A state entropy guided comparative study. Indian J Anaesth. 2016;60:180-6. PMID: 27053781

6. Schmitt JP, Schwoerer D, Diemunsch P et al. [Passage of propofol in the colostrum. Preliminary data]. Ann Fr Anesth Reanim. 1987;6:267-8. PMID: 3498397

7. Birkholz T, Eckardt G, Renner S et al. Green breast milk after propofol administration. Anesthesiology. 2009;111:1168-9. PMID: 19858894

8. Stuttmann R , Schafer C, Hilbert P et al. The breast feeding mother and xenon anaesthesia: four case reports. Breast feeding and xenon anaesthesia. BMC Anesthesiol. 2010;10:1. PMID: 20167123

9. Kutlucan L, Seker IS, Demiraran Y et al. Effects of different anesthesia protocols on lactation in the postpartum period. J Turkish German Gynecol Assoc Artemis. 2014;15:233-8. PMID: 25584032

 

[Arch Guillotti]

Tubal Ligation Any Other Time
If, for any reason, the tubal ligation can’t be arranged during your hospital stay, we can do it as soon as 4-6 weeks after delivery. Call Dr. Mackey’s office to arrange tubal ligation. The sooner a patient calls, the sooner we can get something arranged. We will then schedule a laparoscopic tubal ligation, instead of the postpartum tubal.

If, during your labor or hospitalization, you are having difficulty getting things arranged, contact Dr. Mackey, directly. It is expected that hospital staff and/or the patient can/should/will call, if there is trouble or confusion scheduling this surgery.

http://womens-health-center.org/contact/

What's your point?

 

[BLADEMDA]

What's your point?

There's no good evidence for 6 weeks vs 4 weeks. I can't argue with wanting to wait 6 weeks but I would not cancel a case such as the one discussed on this thread because the evidence is lacking

 

[aneftp]

Thanks again. Appreciate the input from everyone.

Yes the "dogma" of the 6 weeks probably played a part in my thinking. It's a simple case. Sure. Woman was pushing BMI 45-50 whatever. It's just that I've never (been attending for 12 plus years plus residency) had a 3 weeks post partum on the schedule before and I've been at busy ob hospitals before.

 

[pjl]

I would perform anesthesia for this procedure without blinking.

The anesthetic risk postpartum is highest basically immediately postpartum. We do these frequently, with good evidence as little as 2 hours after delivery and as late as 3 days after delivery for our inpatients, under spinal, epidural, or GA.

To make a patient wait after leaving the hospital in order to decrease a risk that you have already proven to be acceptable (willing to do case day 1 postpartum) seems silly. Seriously, you are doing it day 1 for convenience.

Maybe I am a very poor anesthesiologist, but what risk exactly is higher at 3 weeks than it is immediately postpartum?


Sent from my iPad using SDN mobile app

 

[aneftp]

I would perform anesthesia for this procedure without blinking.

The anesthetic risk postpartum is highest basically immediately postpartum. We do these frequently, with good evidence as little as 2 hours after delivery and as late as 3 days after delivery for our inpatients, under spinal, epidural, or GA.

To make a patient wait after leaving the hospital in order to decrease a risk that you have already proven to be acceptable (willing to do case day 1 postpartum) seems silly. Seriously, you are doing it day 1 for convenience.

Maybe I am a very poor anesthesiologist, but what risk exactly is higher at 3 weeks than it is immediately postpartum?


Sent from my iPad using SDN mobile app

No one says anyone is making a woman wait till she leaves the hospital after delivering to have the procedure (unless they are Medicaid and that's some old 30 day rule.....won't get into the politics of that)

People are getting confused with the terminology "interval tubal ligation and immediate post Partum period". It's semantics but it makes a difference in terms of the access to the surgical site for the OB (aka it's easily to do it in the immediate post Partum (Right after delivery or 1 day later).

The "interval post Partum" is a little difference where patient has already left the hospital.

 

[pjl]

No one says anyone is making a woman wait till she leaves the hospital after delivering to have the procedure (unless they are Medicaid and that's some old 30 day rule.....won't get into the politics of that)

People are getting confused with the terminology "interval tubal ligation and immediate post Partum period". It's semantics but it makes a difference in terms of the access to the surgical site for the OB (aka it's easily to do it in the immediate post Partum (Right after delivery or 1 day later).

The "interval post Partum" is a little difference where patient has already left the hospital.

What is the difference in anesthetic risk for an "interval tubal" when compared to the "immediate post partum tubal?"

Being harder surgically is something for the surgeon to determine if it matters. For us, if we are to cancel a case, we should have a valid reason.

If we accept the anesthetic risks immediately post partum, we should accept the same risks (but likely lower) 3 weeks out. I am asking if anyone has a valid reason, that is not present immediately post partum, to not proceed at 3 weeks.


Sent from my iPad using SDN mobile app

 

[Ezekiel2517]

Cancelled the case? lol gotta be kidding me.

 

[aneftp]

Ok. I've learned two new things (thanks for everyone input again). Just talked to the OB today (I am on call this weekend)

1. From anesthesia view point it's safe pretty much anytime. (I got that!)

2. Now here is the kicker. Turns out patient slipped through the crack with insurance pre authorization. OB tells me patient didn't have any pre authorization cause (again the dogma 6 weeks). Cause they won't pay for a "separate gyn procedure" if it's less than 6 weeks. So he would have been doing the procedure for free. And who knows if the anesthesia charges would have been hard to collect as well

That's why the 6 week "dogma". Bottom line:
1. Anesthesia safe regardless of time between delivery for tubal ligation

2. It's always about the money. Commercial Insurance generally doesn't pay the OB/gyn until 6 weeks as a seperate gyn procedure. Thus why they generally don't book for 6 weeks.

 

[IlDestriero]

Well there you go. You wait 6 weeks because you might not get paid. I'll never do one outside of the immediate post partum period.


--
Il Destriero

 

[Urzuz]

Ok. I've learned two new things (thanks for everyone input again). Just talked to the OB today (I am on call this weekend)

1. From anesthesia view point it's safe pretty much anytime. (I got that!)

2. Now here is the kicker. Turns out patient slipped through the crack with insurance pre authorization. OB tells me patient didn't have any pre authorization cause (again the dogma 6 weeks). Cause they won't pay for a "separate gyn procedure" if it's less than 6 weeks. So he would have been doing the procedure for free. And who knows if the anesthesia charges would have been hard to collect as well

That's why the 6 week "dogma". Bottom line:
1. Anesthesia safe regardless of time between delivery for tubal ligation

2. It's always about the money. Commercial Insurance generally doesn't pay the OB/gyn until 6 weeks as a seperate gyn procedure. Thus why they generally don't book for 6 weeks.

Nice, glad you got to the bottom of it! It really goes to show how dogmatic some of our practices are, a lot of times for reasons that are completely unknown to us! And then, like a game of telephone, reasons start to get fabricated as to why things are done a certain way (as evidenced by the multitude of people who responded they would definitely wait 6 weeks...even some of your relatives who are employees who get paid regardless!)

Just a good reminder to all of us to never stop asking questions. Really glad you started this thread!