From the Guidelines
The patient can likely proceed with the scheduled rotator cuff repair if her gastroenteritis and acute kidney injury (AKI) have completely resolved with intravenous fluid therapy, and her mild anemia is evaluated and managed before surgery. However, her mild anemia should be evaluated before surgery, as it may impact oxygen delivery during surgery and recovery 1. The hemoglobin level should ideally be above 10 g/dL for elective orthopedic procedures. If her anemia is significant, the surgeon and anesthesiologist might recommend iron supplementation or postponing surgery until the anemia improves.
Some key considerations for the patient's condition include:
- Normal kidney function should be confirmed with repeat blood tests (BUN, creatinine, eGFR) prior to surgery, as residual kidney dysfunction could affect medication clearance and increase surgical risks 1.
- The patient should also be completely symptom-free from gastroenteritis for at least 7-10 days before surgery to ensure proper hydration and nutritional status.
- A preoperative assessment 2-3 days before the scheduled procedure would be prudent to confirm resolution of all acute issues and fitness for anesthesia and surgery.
- The use of isotonic crystalloids rather than colloids for expansion of intravascular volume in patients at risk for AKI or with AKI is recommended 1.
- Protocol-based management of hemodynamic and oxygenation parameters to prevent development or worsening of AKI in high-risk patients in the perioperative setting may be beneficial, but the evidence is not conclusive 1.
Overall, the decision to proceed with surgery should be made on a case-by-case basis, taking into account the patient's individual risk factors and medical history. The patient's safety and well-being should be the top priority, and any concerns or uncertainties should be addressed before proceeding with the scheduled rotator cuff repair.
From the Research
Patient's Current Condition
- The patient is scheduled for rotator cuff repair in 2 weeks.
- She had gastroenteritis and Acute Kidney Injury (AKI) which resolved with Intravenous Fluids (IVF).
- She also has mild anemia.
Relevant Studies
- There are no studies that directly address the patient's current condition and its impact on rotator cuff repair surgery 2, 3, 4, 5, 6.
- The studies provided focus on the techniques and outcomes of arthroscopic rotator cuff repair, as well as the timing of retears after surgery.
- None of the studies mention gastroenteritis, AKI, or mild anemia as factors that would affect the decision to proceed with rotator cuff repair surgery.
Decision to Proceed with Surgery
- The decision to proceed with surgery should be made on a case-by-case basis, taking into account the patient's overall health and medical history.
- The patient's resolved gastroenteritis and AKI, as well as her mild anemia, should be evaluated by her healthcare team to determine if they pose any risks for surgery.
- The studies provided do not offer any guidance on how to proceed in this situation, and therefore, the decision should be based on the patient's individual circumstances and the healthcare team's professional judgment.