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- Oct 23, 2013
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I know we've discussed this a few times but just wondering what some of you guys in private and academics are doing with elevated blood sugars in preop. specifically had a patient, who went to preop clinic 2 weeks prior to surgery (incisional hernia repair, s/p liver transplant so a huge incisional hernia repair), and had a BS of 350 at preop clinic. preop nurse practitioners leave the patient a message saying call your primary and get your sugar better controlled before surgery. patient arrives on day of surgery with BS of 320, when asked about that message from preop clinic he said he heard it but didn't do much about it (shocker). surgeon is aware and fine with BS that high and suggests some insulin to bring it down preop. Other attendings (anesth) here agree to just control it preop, intraop and good mgmt post-op. I think cancelling the case may be questionable because the patient may just go home and come back weeks later still not optimized. however the patient is on immunosuppression for liver transplant and infection risk with those sugars would be really high. Discussed that with the surgeon and he wishes to proceed. What do you guys think? Whats the liability on us if there is a big wound infection and we document our concern and the willingness of the surgeon to proceed despite that.