‘Not seen’ warning note

PIG Meeting: 1st July 2021

60-year-old lady for elective lumbar foraminotomy


  • NIDDM – HbA1C = 7%
  • OSA – on CPAP
  • Hypertension
  • 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