PIG Meeting: 1st July 2021
60-year-old lady for elective lumbar foraminotomy
- NIDDM – HbA1C = 7%
- OSA – on CPAP
- Current smoker
- Radiculopathy – bilateral foraminotomies at a lower level 6 months ago without issue
- Timing of booking/covid backlog/increased workload at periop clinic – no time to perform a perioperative consult
- Not seen warning note generated
- Cancelled on DOS as on SGLT2 inhibitor, not discontinued
Could this cancellation have been avoided?
- Multiple factors contributing to failure to cease SGLT-2 inhibitor.
- Patient had same surgery recently and it was ceased at that time
- Discharge medications and recent perioperative instructions highlighted she was taking this medication
- SLGT-2 not flagged on the RFA
- Patient may not remember medication instructions
- Surgical registrars often fill the RFA and may not be aware of the perioperative requirements for SGLT-2 inhibitors.
- Additionally, perioperative nurses are triaging many cases per day, they rely on the GP referral/RFA and often don’t have enough time to read through the previous clinic notes
Would it have been appropriate to proceed?
- Ultimately it is the decision of the procedural anaesthetist
- According to most recent ANCZA/ADS statement, it may be appropriate to perform day surgery on patients who have continued SGLT-2 inhibitors under certain conditions. (See table below)
- This surgery may be complex due to previous surgeries
- Patient has good glycaemic control but significant co-morbidities.
- Elective procedure, consensus that best to postpone